Clinico-Radiological Profile of Spine Injury at SKIMS

BACKGROUND: Global prevalence rates of traumatic SCI varied from approximately 200 to 1000 per million and data on incidence varied from approximately 15 to 50 per million. Traumatic spinal injuries (TSI) can comprise column fractures, spinal cord injury or both.5 Spinal injury is one of the most devastating injuries having a great impact on patients, their families and the society. It may lead to serious disability when involving the spinal cord with long-term medical complications, including pressure ulcers, autonomic dysreflexia, deep venous thrombosis and pneumonia. This significantly impacts rehabilitation and long-term quality of life. OBJECTIVES: To determine clinico-radiological profile of spinal injuries in Kashmir valley. To identify prognostic factors and determine outcome. PARTICIPANTS: All patients who presented to SKIMS, Neurosurgery department with Spine Injury. STUDY DESIGN: Prospective Observational Study (January 2019 to December 2019) METHODS: This prospective study was conducted in the Department of Neurosurgery, S.K.I.M.S, Soura over a period of one year from 1st January 2019 to 31st December 2019 and included all the patients with spinal injuries presenting to the Department of Neurosurgery, S.K.I.M.S over this period. Data were extracted and spine injuries severity was classified using American Spinal Injury Association (ASIA) scale. The patient was then subjected to either conservative or surgical management depends upon the type of injury.  Outcome was measured by modified Rankin Score (mRS). RESULTS: In our study of 1 year period at SKIMS, spine trauma was more common in males than females with male to female ratio 2.7:1, with mean age of 38.27 years. Majority of spine injury was seen in laborer (46.5%) and most of the spine trauma occurred during >12pm to 6pm (58.1%). Spine injury was most commonly (41.9%) seen during autumn season (September, October, November). The most common cause of spine trauma was fall and it accounts for about 86% followed by Road Traffic Accident (RTA) (12%). In spine trauma due to fall; fall from walnut tree (21.6%), followed by apple tree (10.8%). American spinal cord injury association (ASIA) scale at the time of admission was grade E (39.5%) most commonly. Most common level of spine injury in our study was seen in cervical region (44.2%) followed by 30.2% in thoracic region and about 58.1% had single level fracture followed by 33.7% in two level and 6.9% in ≥3 levels. The most common types of fractures was burst fractures (31.4%) followed by wedge fractures (18.6%). About 60.5% of patients underwent surgery while 39.5% where managed conservatively. In patients who were surgically managed about 40.4% of injury was seen in cervical region. The mean duration of hospital stays was 9.2 days with range of hospitalization from 1 to 30days. The most common associated injuries was head injury (11.6%) followed by chest injury (4.6%). The most common complications associated with spinal injuries in our study was the Foleys catheter requirement (44.2%), requirement of tracheostomy (8.1%), bed sores (10.5%), DVT (6.9%). About 40.7 % (n=35) of patients has mRS score of 1, followed by 18.6%, 12.8%, 12.8%, 9.3%, 3.5% and 2.3% has score of 5, 4, 6, 0, 2 and 3 respectively at the time of discharge. The mortality rate in our study was 12.8%, and most of the patients who died had cervical spinal injury and the most common cause of death in our study was shock and respiratory failure (36.4% each) followed by sepsis (18.2%) and head injury (9.1%). CONCLUSIONS: As per our data spine injury is most commonly caused by fall, RTA so preventive measures, teaching and awareness programme about spinal injury to health workers and general public regarding immobilization of spine and transportation to higher center may help prevent secondary injury to spinal cord and improved outcomes of patients.