{^1,3Post Graduate, ²Assistant Professor, Department of Orthopaedics} {⁴Registrar, Department of Anaesthesia} Government Medical College Jammu, INDIA.

Email: draamirhussain13@gmail.com

RESULTS

Out of 282 patients, most of the patients were in the age group 51-60 (29.43%) and 41-50(29.08%).Youngest patient was 17 years and oldest 95 years. Mean age was 51.62 years. Majority of the patients were male (70.92%) while 29.08% patients were female. Male to female ratio was 2.4:1. Peak age in female patients was 51-60 years (31.71%) and in male patients was 41-50 years. The mean age in female was 55.06 years and in male was 50.21 years. Traumatic spine injuries in this study were caused by three modes, one being road traffic accidents (54.96%), second being fall from height (43.26%) and third being assault (1.77%). Out of 282 patients, 161 patients (57.09%) had no associated injuries. Common associated injuries were hemoperitoneum (9.57 %), head injury (9.22 %), fracture humerus (6.74 %) and fracture clavicle (6.38 %). Others were fracture calcaneum (2 patients), fracture tibia (4 patients), fracture forearm (3 patients), etc.

Table 1: General characteristics

Majority of spine fractures occurred at cervical (41.84%) followed by Lumbar (27.30%) followed by thoracic (19.50%) vertebral level. Other injuries were 4.96% at both thoracic and lumbar vertebral level, 3.55% at both cervical and thoracic vertebral level, 2.13% at Lumbar and sacral vertebral level, 0.35% at both cervical and lumbar vertebral level, 0.35% at both cervical and sacral spine level.

Table 3: Distribution of injury level of study subjects.

Out of 282 patients, 50.71% patients had no Neurodeficit and 49.29% patients had Neurodeficit.

On pre -operative assessment 50.71% patients had ASIA score of E, 15.60 had ASIA score of C, 12.06% had ASIA score of D, 13.48% had ASIA score of A and 8.16% had ASIA score of B. Mean of SLICS score was 3.66 and mean duration of TLICS score was 3.8. 74.11% patients were treated conservatively and 25.89% patients were operated.

Table 4: Distribution of pre -operative assessment of study subjects.

Follow up ASIA score after 2 weeks in patients was A in 13.48% patients, B in 8.16%, C in 15.60%, D in 12.06, E in 50.71%. Follow up ASIA score after 3 months in patients was A in 8.27% patients, B in 5.12%, C in 5.91%, D in 14.57, E in 66.14%. Follow up ASIA score after 6 months in patients was A in 8.60% patients, B in 4.52%, C in 4.07%, D in 16.29, E in 66.52%. Follow up ASIA score after 9 months in patients was A in 8.22% patients, B in 6.85%, C in 4.11%, D in 19.86, E in 60.96%. Follow up ASIA score after 12 months in patients was A in 14.29 patients, C in 10%, D in 23.81, E in 61.90%.

Table 5: Distribution of follow up ASIA score of study subjects.

Total deaths in our study were 30 out of 282 patients. Patients survival was 84.68% in patients with cervical spine injury, 92.11% in patients with thoracic spine injury and 93.90% in lumbar spine injury. The mean day of death after treatment in cervical spine injury was 17.58, thoracic spine injury was 179.17 and lumbar spine injury was 167.

Table 6: Outcome after treatment

DISCUSSION

Traumatic spine injuries are common as well as important medical problem in today’s world which our society is facing because of increased vehicular trauma as well as professions needing climbing, the entertainment and sports has added to the numbers. The spine injury besides a medical problem to the individual and health system is a social problem for society since it takes away the capacity to work, make the patient dependent on others not only for day to day mobility but also for the financial support. All these together has influence on the physical, psychosocial and financial well-being on individual, family and the society. In the series of Chamberlain JD et al.,⁶ out of 932 patients, male to female ratio was 1.88:1. The mean age in tetraplegics was 53.5 years and in paraplegics was 43.8 years. Over all mean age was 48 years. Johansson et al.,⁷ out of 346 patients, 72.3% were males and 27.7% were females. The mean age in this study was 58.9 years. Similar findings were noted in present study. Male predominance in our study is due to male dominant professions like climbing trees, doing labour works, driving etc., whereas most of females are limited to only house hold works. Ahuja et al.,¹¹ in a study of 313 patients, 182 patients were operated early and underwent surgery within 24 hours and 131 patients were operated after 24 hours. The primary end point was change in American Spinal Injury Impairment Scale (AIS) at the end of 6 months. The group who underwent surgery under 24 hours, 19.8% demonstrated a 2 or more grade improvement in AIS at 6 months, whereas 8.8% of patients show same improvement who had undergone surgery after 24 hours. Complications rate was 24.2% in early group and 30.5% in late group. In a study, 70% of patients initially diagnosed as ASIA A didn’t convert, as did 90% with ASIA D. On the whole 68% of total patients didn’t convert, while 30% of patients improved and 2% deteriorated.⁹ Middendrop et al.,¹⁰ in his series of 273 patients observed that ASIA A were 161, ASIA B were 37, ASIA C were 43, and ASIA D were 32. 42(26%) converted from ASIA A, 27(73%) from ASIA B, 32(75%) from ASIA C, 5(16%) from ASIA D. In present study, patients survival was 84.68% in patients with cervical spine injury, 92.11% in patients with thoracic spine injury and 93.90% in lumbar spine injury. From above we can conclude that that higher is the level of injury, less is the percentage of survival. The mean day of death after treatment in cervical spine injury was 17.58, thoracic spine injury was 179.17 and lumbar spine injury was 167. In cervical spine injury, patients survival was 27.28% with preoperative ASIA A, 66.67% with ASIA B, 92.31% with ASIA C, 100% with ASIA D and 98.48% with ASIA E. In thoracic spine injury, patients survival was 75% with preoperative ASIA A, 71.43% with ASIA B, 94.12% with ASIA C, 100% with ASIA D and 100% with ASIA E. In lumbar spine injury, patients survival was 50% with preoperative ASIA A, 75% with ASIA B, 100% with ASIA C, 100% with ASIA D and 100% with ASIA E. In lumbar ASIA A were 8 patients out of which 4 died due to long standing bed sores. Choi JH et al.,¹¹ studied 80 patients, falls from heights were the most common cause of TSI, followed by road traffic accidents. 78% of the admitted patients underwent at least one surgical procedure. Without intra-operative imaging, 4 patients (6%) had wrong level surgery, and 1 patient (2%) had misplacement of pedicle screws. Sacral decubitus ulcers were the most common non-surgically related complication. Antibiotics were administered to >90% of patients. There were no in-hospital mortalities. Of the 60 spinal cord injury (SCI) patients, 32% (19/60) showed improvement in their ASIA grade at the time of discharge, and 52% (31/60) showed no change. At follow-up, 32% (19/60) of SCI patients reported improvement, and 8% (5/60) reported no change. However, 36 SCI patients (60%) were lost to follow-up. They concluded that despite significant limitations in medical resources, spine surgery in Cambodia appears promising with reasonable complication rates, no in- hospital mortality, and trends of clinical improvement. The overall surgical rate for TSI patients was 78% with no significant difference between the surgical rates of complete, incomplete, and non-SCI patients. Traumatic spine injuries can be isolated spine injuries or with other associated injuries Spine injuries can be vertebral column fractures and with or without involvement of spinal cord. Pattern of vertebral fractures can be of Compression type, Burst type, Flexion type, Extension type, Distraction type and dislocation type. The most common causes of cervical spine injuries are motor vehicle accidents(41%), falls(27%), violence (15%), sports related injuries (8%), and fall of heavy object on head.¹² The overall mortality rate from cervical spine injuries is 6%.¹³ Treatment of a fracture begins with pain management and stabilization to prevent further injury. Other body injuries (e.g., to the chest) may be present and need treatment as well. Depending on the type of fracture and its stability, bracing and/or surgery may be necessary.

CONCLUSION

In present study, majority of spine fractures occurred at cervical (41.84%) followed by Lumbar (27.30%) followed by thoracic (19.50%) vertebral level. Out of 282 patients, 50.71% patients had no neurodeficit and 49.29% patients had neurodeficit. Overall 30 patients died. 19 patients died who at injury at cervical level, 6 patients had injury at thoracic level and 5 patients had injury at lumbar level, the leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long standing bed sores.

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