OUTCOME OF NON-OPERATIVE TREATMENT OF TRAUMATIC CERVICAL SPINE INJURIES; CONTROVERSIES OF CARE AND FUTURE DIRECTION

*Mathias Nnanna Nnadi and Olufemi Babatola Bankole

ABSTRACT

Traumatic spinal injury is a devastating neurosurgical condition. The cervical region is the most involved region. Morbidities arising from the complications are common. We prospectively studied the outcome of patients with traumatic cervical spinal injuries managed in our center over a four and half year period. Objective: The objective was to evaluate the outcome of non-operative treatment of the patients using American Spinal Injury Association (ASIA) impairment scale. Methods: It was a prospective study on patients managed non-operatively for traumatic cervical spine injuries in our center from August 2010 to January 2015. Patients were managed in accident and emergency using Advanced Trauma Life Support protocols, ensuring stabilized neck, normotension, euvolemia and oxygen saturation of ≥95%. History and physical examinations were carried out. Patients were admitted to the wards or intensive care unit and their treatment continued until discharged. Data were collected using structured proforma which was component of our prospective data bank that was approved by our ethics and research committee. Data were analyzed using Environmental Performance Index Info 7 software. Results : There were 81 patients. Males were 53. Mean age was 37.11 years. Forty seven patients had vehicular accident. Patients with incomplete injury recovered better. ASIA grade at presentation and comorbidity significantly affected the outcome. Conclusions: Males were more affected by the lesion, while majority had vehicular accident. ASIA grade at presentation significantly affected neurological recovery. From literature, central nervous system plasticity and reorganization appeared to be the key factors in recovery.

Keywords: cervical spine injury, neurological recovery, trauma.