Patterns, Management, and Early Outcomes of Traumatic Subaxial Cervical Spine Injuries at Kenyatta National Hospital

Abstract

Background: The risk of subaxial cervical injuries has increased with increasing road traffic accidents. Traumatic subaxial cervical spine injuries (TSCI) are significant due to their potential for severe neurological deficits and long-term disability. The most common levels of injury involve the lower cervical spine (C5-C7), but injuries can occur at any level from C3 to C7. The injury patterns may include fractures, dislocations, ligamentous injuries, and spinal cord contusions or transections. The presence and severity of spinal cord injury correlate with the extent of bony and ligamentous damage. However, there are no studies in local context investigating the patterns, management, and early outcomes of subaxial cervical spine injury patients presenting to Kenyatta National Hospital for treatment. Broad objective: To determine the patterns, management, and early outcomes of subaxial cervical spine injuries at Kenyatta National Hospital between 1st January 2020 and 31st January 2023. Methods: This was a retrospective study conducted between 1st January 2020 and 31st January 2023. A census was done where all the 94 patients who presented to the Kenyatta National Hospital with subaxial cervical spine injuries were included in the study. A structured data collection form was used to collect data. Stata version 17 was used for analysis. Analysis was both descriptive and inferential. Categorical data was summarized using frequencies and percentages. Continuous variables were summarized using mean and standard deviation. Fischer’s exact test or Pearson chisquare test were used to investigate factors associated with early outcomes of subaxial cervical spine injuries. The level of significance was investigated at p<0.05. Results: The average age was 42.4(SD±15.3) years. The majority of the patients 91.5%(n =86) were male, 47.9%(n =45) had secondary education as their highest level of education, 38.3%(n =36) had motor vehicle accident injuries, 28.7%(n =27) fall from height, 16%(n =15) had motorcycle accident injuries and 10.6%(n =10). In most of the patients, 92.6%(n =87) had injury in the cervical region, 4.3%(n =4) had injury in the cervical and thoracic region while 3.2%(n =3) had injury in the cervical and lumbar region. The average total SLIC score was 4.8(SD±2.5). The majority of patients,71.3%(n =67) of the patients were managed using non-surgical approaches while 26.6%(n =25) were managed using surgical approaches. Thirty-three (35.1%) of the patients were managed using cervical collar, 28.7%(n =27) utilized skull traction, 13.8%(n =13) used Philadelphia collar. The common surgical approaches included anterior cervical discectomy and fusion 9.6%(n =9) and anterior Cervical Corpectomy and Fusion. The median length of hospital stay was 36 (10 – 64.5) days with a range of stay being 1- 234 days. More than half of the patients, 51.1%(n =48) had complications. The common complications identified included persistent neck pains 20.2%(n =19), bedsores 16%(n =15) and persistent neck stiffness 12.8%(n =12). Mortality rate within one week was 14.9%(n =14). Conclusion and recommendations: The SCSIs are mainly caused by motor accidents with Subaxial Injury Classification (SLIC) score is essential in the management approach adopted. However, these injuries have been associated with a high rate of

complications. Thus, there is need to implement standardized protocols for the assessment and classification of spinal injuries using the SLIC score.