Traumatic spinal injuries: A retrospective epidemiological analysis following the 2018 driving policy reform in Saudi...

The epidemiology of traumatic spinal injuries (TSI) differs across various regions and is influenced by national income, infrastructure, and culture. TSIs are a source of high morbidity and mortality, requiring considerable resource allocation. Saudi Arabia's 2018 decision allowing women to drive introduced a new demographic element, potentially shifting TSI epidemiology. In this paper, we aimed to study patterns and outcomes of TSIs, including sex-based analyses, and to identify demographic, injury-related, and in-hospital factors associated with length of hospital stay, neurological severity, and spinal surgery requirement.

This is a retrospective observational study conducted in a tertiary center between 2018 and May 2025. A total of 5380 computed tomography scans were screened. All patients with a diagnosis of spinal injury caused by a traumatic mechanism were included. Patients' demographics, mechanism of injury, injury level, associated injuries, AIS grade, hospital course, and disposition were collected and analyzed.

623 TSI patients were included. Most of them were males (78.5 %) and Saudi nationals (74.2 %), with a male-to-female ratio of 3.7. The average age was 32.5 (±15.9) years. Substance use was documented in 7.4 % of cases. Four-wheel motorized-vehicle accidents (Four W-MVA) predominated (57.6 %) and were more common among Saudis (68.4 %), whereas falls from height (36.0 %), pedestrian injuries (21.1 %) were more common among non-Saudis. The most common injury was at the lumbar region (53.9 %), and most patients were neurologically intact (AIS E 93.7 %). Female sex and older age were associated with longer length of stay (LOS). Longer LOS was independently associated with prior psychiatric illness (RR=3.77), higher AIS severity (RR=1.22), pulmonary infection (RR=3.11), and ICU admission (RR=2.01). Higher AIS severity was linked to cervical involvement (per injured level RR=1.10) and vertebral subluxation/dislocation (RR=1.24).

The epidemiology of TSIs has demonstrated notable shifts in demographics, patterns of injury, and outcomes. This study highlights the need for targeted interventions, including intensified efforts to enforce traffic regulations, addressing health disparities experienced by non-Saudi residents, and an expansion of mental health services.