Association Of Causative Mechanisms Of Traumatic Spinal Injuries With The Clinical Presentations And Outcomes In Tanzania

Abstract

Introduction: Traumatic spinal Injuries (TSI) can cause permanent disability, and knowledge of clinical characteristics and outcomes of different mechanisms of injury is required to develop effective prevention strategies. Objective: To investigate the association of mechanisms of TSI with their clinical level, severity, and outcomes. Method: Patients admitted with TSI to Muhimbili Orthopedic Institute (MOI) between September 2016 and December 2021 were included. Mechanisms of injury, ASIA grades, and injury level were examined for association with median change in ASIA grade and mortality at discharge. Chi-square, Fisher’s exact, and Kruskal-Wallis tests were used for bivariable relationships and regression analysis for outcome variables. Statistical analysis was conducted using R studio (4.1.2). Result: We included 629 patients, with a mean age of 36.1±12.2 years. The cohort consisted primarily of males (n=535, 85%). Road traffic accidents (RTA) (48%) were the most frequent mechanism of injury, and cervical spine (42%) was the commonest level of injury, with ASIA A grade (42%) being the most frequent severity. RTAs were often associated with cervical spine injuries [OR 1.57 (1.12-2.20), p = 0.007]. Young age [median 30 years (IQR 24-35)] was more often associated with ASIA A injuries [OR 1.48 (1.02-2.16), p = 0.03]), with higher rates of ASIA A in cervical spine injuries [OR 4.36 (2.60-7.53), p<0.001]. In regression analyses, ASIA B-D compared to ASIA A were associated with neurological improvement (β = 0.25, p <0.001) and had significantly lower mortality [aOR 0.10 (0.04-0.24); p<0.001]. Conclusion: Road traffic accidents are the most prevalent cause of spinal trauma, affecting young age groups, and are most often associated with fatal ASIA A cervical injuries in this LMIC urban setting. Considering the socioeconomic impact of these findings, RTAs deserve prioritization in neurotrauma preventive strategies.