Cervical Spine Injury: Nature and Complication

BACKGROUND: Traumatic cervical spine injury is the commonest and most devastating injuries of the musculoskeletal system occurring more commonly in young patients from high energy vehicular accidents. This is particularly important considering the state of health care delivery system in Nigeria, increasing use of vehicles and belligerent flaunting of traffic rules. This study highlights the pattern of the injuries of the cervical spine as a distinct pathological entity which has not been documented before, the difficulties, the complications encountered and our attempt at overcoming these. METHODOLOGY: This is a three year prospective analysis of all patients with cervical spine injury. Treatment was conservative, Frankel's gradling was used as index of monitor, complications were documented and treated as they occurred and follow-up was for a minimum period of 12 months. RESULT: Twenty-eight patients were recruited comprising 25 (89.3%) males and three 910.7%) with a mean age of 30.5 (+5.54) years. Twenty five (89.3%) patients were aged 20.35 years. Road traffic accident was the leading cause in 22 (78.6%). Five (22.7%) patients of these had worsening of neurological status on transit to the hospital soon after the accidents. Ten (35.7%) patients had complete cord injury, 13(46.4%), incomplete and five had no cord injury at all. Twenty (71.4%) patients sustained associated injuries, facial lacerations and head injury being the commonest. Eleven (39.3%) patients had an improvement of at least one Frankel's grade during the course of rehabilitation. The commonest complications in our series were, urinary tract infection in 11 (39.3%); pressure ulcers in 11 (39.3%). Others were bronchopneumonia 9(32.1%); muscle spasms 9 (32.1%). Mortality was 7.1% both from respiratory failure. The mean duration of hospital stay was 95.4 (+78.5; range 0-2210 days. CONCLUSION: The outlook for the cervical injured patient remains bleak. More attention should be devoted to preventive measures backed by adequate and appropriate government legislation. The Federal Road Safety Corp should be empowered and their scope widened to increase their relevance in the community. A well run ambulance service scheme anchored by the ministry of health is long overdue and there is no better time than now to establish regional spinal center for adequate rehabilitation of the spinal injured patient. KEY WORDS: Traumatic cervical spine injury; Frankel's grade; urinary tract infection; bronchopneumonia, spinal center. Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 149-16

The Mass Casualty from the Jos Crisis of 2008: The Pains and Gains of Lessons from the Past

Background: Following the mass casualty of September 2001, we experienced challenges due to the prolonged nature of the crisis and disaster response. We subsequently made changes to our response protocol which were soon tested in the mass casualty resulting from the violence ofNovember 2008 in our city. We present here the management of the mass casualty situation that resulted from that crisis.Patients and methods: A retrospective analysis of the management of the patients who presented following thecrisis. Data was collected from the Emergency Room, theoperating room records and the crisis register. Informationgathered included patient demographics, cause of injury, mechanism, body part affected, treatment, morbidity and mortality. Data was analyzed using Epi Info statisticalsoftware using simple percentages.Results: One hundred and three patients presented over 2 days. There were 101 males (98.1%) and 2 females (1.9%) patients. The ages ranged from 11-65 (+ SD 10.23) years. Injury was caused by gunshots in 71 (68.9%) patients and machetes in 23 (22.3%) patients. The most frequently affected body parts were the lower limbs in 36 (35.0%) patients, upper limbs in 29 (28.2%) patients, chest in 18 (17.5%) patients and abdomen in 14 (13.6%) patients.Nineteen (18.4%) patients required formal surgicalprocedures, mainly exploratory laparotomy, 10 (9.7%).Complications were seen in 14 (13.6%) patients, 11 (10.7%) of these were infection related. There were 3 (2.9%) hospital mortalities. All had severe head injuries.Conclusion: Majority of the injuries were due to gunshots and only one fifth required urgent life saving interventions. From previous experience, effective and continuous IncidentCommand and Mass Casualty Commander positions , andactivation of unit specific protocols within the hospitalensured a hitch free hospital response and enabled the hospital to return to routine activities within 24hours

Acute Traumatic Spinal Cord Injury; does a Low Tesla Magnetic Resonance Imaging Features Correlates with Neurological Status and Predict Early Outcome?

Background: Traumatic spinal cord injury (TSCI) is a devastating disease, hence the need to identify clinical and radiological injury features that predict neurological improvement. Aims: The aim is to determine the correlations between American Spinal Injury Association (ASIA) Impairment Scale (AIS) and magnetic resonance imaging (MRI) features in patients with TSCI and identify predictors of neurological improvement. Settings and Design: This is a prospective cohort study. Subjects and Methods: Seventy-three patients with TSCI managed over a period of 18 months were studied. Neurological assessment of these patients was done at admission and 3-month post-injury using the AIS score form. The various MRI (0.3 Tesla Machine) features of these injuries were identified and measured using a RadiAnt DICOM Viewer 4.0.3 (64-bit). Statistical Analysis: Correlation and regression analysis were done using Spearman’s rank correlation, and logistic regression, respectively. A P < 0.05 was used as the level of significance. Results: Spinal cord edema (26.0%) and cord contusion (34.2%) were seen in most patients with incomplete injury, while spinal cord hemorrhage and transection were observed in patients with ASIA A injury. Asignificant correlation exists between maximum canal compromise (MCC) (ρ = −0.39, P < 0.001), maximum spinal cord compression (MSCC) (ρ = −0.44, P < 0.001), and length of spinal cord lesion (ρ = −0.77, P < 0.001) with AIS at admission. The independent predictors of AIS improvement include MSCC, MCC, length of spinal cord signal change, and cord contusion. Conclusions: MRI features significantly correlate with the neurological status of TSCI and can be used to predict early neurological improvement in these patients

Jos christmas eve bomb blast: confronting new challenges with old resources

Background: Jos, Nigeria has witnessed several mass casualty incidents from sectarian crises, with mechanisms of injury mainly from blunt forces and use of machetes and less from gunshots. In December 2010, for the first time, twin bomb blasts detonated at a market generating casualties and triggering another crisis. We sought to describe peculiarities of this novel mechanism of mass casualty.Methods: A retrospective descriptive study of patients who presented to our hospital with injuries sustained following the Jos Christmas Eve bombing of 2010.Results: Of the 90 patients that presented over 4 days, 81 were males and 9 females. Age ranged from 2 to 76 years with a mean of 36.2 years, SD=± 16. There were 31 (34.4%) blast injuries and 35 (38.9%) gunshot injuries. Majority of the wounds involved the lower limbs in 39(43.3%) patients, and upper limbs in 24(26.6%). Forty three (47.8%) patients required only debridement and 13(14.4%) needed only wound dressing. Definitive procedures done were open reduction and internal fixation in 7(7.7%) patients, laparotomy in 5(5.5%), amputation and local wound exploration in 3(3.3%) each, and chest tube insertion in 2(2.2%) patients. Duration of hospital stay ranged from 0-84 days. More than half of the 14(15.5%) complications were infective in origin. There were 7(7.7%) mortalities. The hospital cost was 14 times higher than that of previous crisis that did not involve bomb blast.Conclusion: The bomb blasts generated predominantly limb injuries that required a lot of resources and prolonged hospital care..A disaster response protocol that envisages injuries arising from this mechanism is essential