Traumatic spinal injuries (TSI), including fractures to the spinal column and spinal cord injury (SCI), represent a significant global disease burden, especially in low- and middle-income countries (LMIC) 1,2. It was estimated that in 2016, there were 930,000 new cases and 27 million prevalent cases of SCI, leading to 9.5 million years of life with disability due to SCI 1. Globally, falls and road traffic accidents were the leading causes of SCI 1. A recent systematic review summarized 102 studies. It concluded that the burden of TSI was higher in LMIC than in high-income countries (13.69 vs 8.72 per 100,000 persons), and approximately 48.8% of patients with TSI required surgery 2. As orthopaedic and neurosurgical care continues to reach low-resource settings, patients in LMIC are starting to receive appropriate surgical intervention.
Our group summarized 180 patients with TSI in the primary referral hospital of MOI, revealing several essential treatment patterns: TSI affected young males primarily (83%), and the average distance from the site of trauma to MOI was 303km, with an average of 7.5 days after injury 3–5. Traffic accidents and falls were the most common mechanism. Of the 40% of patients who underwent surgery, 21% improved an ASIA grade at discharge. Factors most predictive of long-term neurologic status were undergoing surgery and shorter time to surgery 4. We discovered that since the hospital could not pay for spinal implants, those who underwent surgery were not selected based on fracture severity or neurologic status but instead based on their ability to pay for implants 6. As a result, a large portion of patients with incomplete neurological injuries left to be untreated. On the other hand, the surgeries performed resulted in overall good outcomes without significant technical complications, indicating that the surgeons are well trained and capable of doing these types of spinal instrumentation surgeries.
Additionally, our team's pilot trials have shown that a better neurological outcome can be achieved while dramatically reducing the time to surgery 3. More recently, with the help of a prior implant grant from Depuy Spine, our team showed, using preliminary data, that proactively treating spinal cord injuries in low-income settings saves both the hospital and the patient money for a short follow-up period 7. It details the steps that must be performed to effectively treat traumatic spinal cord injuries and demonstrates how beneficial it is for everyone concerned if the patient receives interventive care, which is a breakthrough in the literature on low-income settings.
1 Feigin VL, Nichols E, Alam T, et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18: 459–80.
2 Kumar R, Lim J, Mekary RA, et al. Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume. World Neurosurg 2018; 113: e345–63.
3 A L, Ee K, R N-R, et al. Spinal trauma in Tanzania: current management and outcomes. J Neurosurg Spine 2019; 31. DOI:10.3171/2018.12.SPINE18635.
4 Magogo J, Lazaro A, Mango M, et al.Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery. Glob Spine J 2021; 11: 89–98.
5 Lessing NL, Mwesige S, Lazaro A, et al.Pressure ulcers after traumatic spinal injury in East Africa: risk factors, illustrative case, and low-cost protocol for prevention and treatment. Spinal Cord Ser Cases 2020; 6: 48.
6 Lessing NL, Lazaro A, Zuckerman SL, et al.Nonoperative treatment of traumatic spinal injuries in Tanzania: who is not undergoing surgery and why? Spinal Cord2020; 58: 1197–205.
7 Lessing NL, Zuckerman SL, Lazaro A, et al.Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center. Glob Spine J 2022; 12: 15