To analyse the causes and factors associated with mortality in patients admitted to ASCI unit in a low- or middle-income country. The study was performed at a Tertiary Hospital at Groote Schuur Hospital, Cape Town South Africa Data between 1996 –2022 were retrospectively collected from hospital records of patients admitted to the ASCI Unit. There was approximately 3223 admissions for the study period. 682 patients were confirmed dead 87% were male and 64% were unemployed. The mean age was 46 years (ranging from 14 – 87 years). A 1/3 of injuries were caused by a MVA, a ¼ by a fall (low energy and from a height), and 1/5 by a gunshot wound. Average length of stay was 47 days (SD = 52 days), ranging from as short as 1 day to 512 days for one patient. Majority (65%) were admitted for more than a week but less than 2 months 32% were ventilated, and 17% with a CPAP facemask. 10% of patients had a pre-existing ulcer prior to admission. 65% of patients had surgery via the posterior approach, 33% via the anterior approach. On average patients died within 5 years of being admitted to hospital, ranging from dying in the same year as the injury to 20 years later. 73% of the deaths were classified as natural deaths and 20% as unnatural. There is a high mortality in patients with acute spinal cord injury, causes are multifactorial, and in depth critical analyses is required to improve clinical outcomes and rationalise resource allocation.
A retrospective follow-up study was done, assessing regional practices in acute cervical reduction in hospitals in the Western Cape. The constitutional court ruled on the urgency in managing cervical dislocations, and our task is to ensure that medical treatment is optimized to comply with best medical practice and the apex court. A questionnaire was distributed and completed by emergency departments at each hospital, the results retrieved, analysed, and compared to a similar survey done in 2016. Protocols for managing cervical spine dislocations had improved from 80% having no protocols to only over half of facilities (52,6%) not having protocols in place. Inadequate equipment availability remained a problem with only 50% of facilities having adequate equipment available in 2016 to 43,6% in 2023. 10,3% of participants did not know if there was equipment available. In terms of knowledge, there remained poor formal training with a drop from 93% participants identifying that the main indication to attempt emergency cervical reduction was acute cervical dislocation with worsening neurology, to only 46,2%. However, there was an increase in the number of participants who thought reduction was safe. The same percentage of participants from 2016 to 2023 would attempt emergency cervical reduction if given adequate training. Previously we found that most Western Cape hospitals had inadequate protocols, training, and equipment for cervical reductions. In 2023, more hospitals in the Province have protocols in place for cervical reductions and the same percentage of doctors would attempt emergency cervical reduction with adequate training. However, equipment and training for management of acute cervical dislocations has not improved. We conclude that most Western Cape Hospitals are unprepared to adequately manage acute cervical dislocations.
Cervical spine injured patients often require prolonged ventilatory support due to intercostal paralysis and recurrent chest infections. This may necessitate tracheotomy. Concern exists around increased complications when anterior cervical spine surgery and tracheotomies are performed. The primary aim of this study was to evaluate the effect of tracheostomy in anterior cervical surgery patients in term of complications. In addition, the aetiology of trauma and incidence of anterior surgery and ventilation in this patient group was assessed.Background:
Objective:
Debate exists in the literature about the surgical management of sub-axial cervical burst fractures regarding the approach and types of fixation of these injuries. Our Acute Spinal Injury (ASCI) unit prefers anterior only cervical corpectomy and plate fixation in the management of these injuries. The objective of this study was to radiologically assess the long term outcomes (minimum 2 yrs) of our series. Patients were identified using the Acute Spinal Injury Unit (ASCI) database that had had anterior only corpectomy and plate fixation for trauma as a standardised procedure between 2006 and 2009. Initial post-op radiological review included the sagittal alignment, hardware characteristics and surgical technique. Radiological review after a minimum of 24 months involved the union, sagittal alignment, hardware characteristics, graft incorporation and adjacent level degeneration at the site of injury.Purpose of Study
Patients and Methods
Cervical bifacet dislocations are devastating injuries and require early reduction and surgical stabilization. Closed reduction is safe and neurological deterioration is rare. Pre-reduction MRI can cause clinical uncertainty as to the safety of closed reduction when a significant sequestrated disc is found. This study explores the direct cord pressures in a bifacet dislocation model with the use of fresh frozen cadaver cervical spines and a Tekscan Pressure Measurement System. Surgical dislocations were created and pressure monitors inserted into the canal. Pressures on the cord from the posterior-superior edge of the caudal body as well as that from the cranial body were assessed at the level of the dislocation. The effects of the presence of a disc and its size, reduction angles and level of dislocation before and during closed reduction were evaluated. The average dislocated spinal cord pressures were measured at 3.81 kPa and increased to 20.22 kPa under traction. This decreased to 1.295 kPa after cervical spine reduction. Average cord pressures as well as peak loading pressures were shown to increase with the increasing size of the prolapsed disc and diminished once the spine was reduced.Method
Results
The vast majority of C2 ring fractures can be managed non-operatively but occasionally the situation precludes this and surgery is considered. Thus study reviews our indications and surgical options in this scenario. A retrospective review of patient folders and x-rays was performed of all patients with C2 traumatic spondylolisthesis that were managed surgically between 2003 and 2012. Demographic data, particularly indications for surgery, the options chosen and the clinical and radiological outcomes were analysed.Purpose of study
Methods
