Presentation, Management and Outcomes of Thoracolumbar Spine Trauma in East Africa: A Retrospective Cohort Study

Introduction: Thoracolumbar (TL) spine trauma is common and can cause disability, deformity, and neurological deficit. The aim of this study is to: (a) describe the presentation and operative treatment patterns and (b) report predictors of surgery, neurologic improvement, and mortality.

Methods: A retrospective cohort study of TL spine trauma patients presenting to a prominent East Africa referral center from September 2016 - December 2020 was performed. Demographic, injury, and operative data were collected. Fractures were classified according to AO TL fracture classification. Univariate/multivariate logistic regression was performed to assess predictors of operative treatment, neurologic improvement, and mortality.

Results: Of 257 patients with TL spine trauma who presented during the study period, 167 (64.9%) were treated operatively on a median post-admission day 17.0 (7.0–30.0). Only three patients (1.2%) died. 43.6% of patients were involved in a road traffic accident. The most common fracture pattern was AO Type A fractures (78.6%), and most were burst fractures (61.1%). Most patients (97.6%) had a laminectomy and posterolateral fusion. Patients less likely to have surgery had intact injuries (OR 0.27, 95% CI 0.13 - 0.54, P< 0.001) and a longer time from injury to admission (OR 0.95, 95% CI 0.92-0.99, P = 0.007). The neurological improvement rate was 11.1%. Operative treatment was associated with neurologic improvement in univariate testing (OR 3.83, 95% CI 1.27-16.61, P < 0.001).

Conclusion : Approximately 2 out of 3 patients with TL spine trauma were treated with surgical decompression/stabilization. Decreased surgery rates were seen in patients who were neurologically intact and had a longer time from injury to admission. Surgery was associated with neurologic improvement. These findings highlight several themes surrounding the treatment of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement.