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