|Ahead of print publication
Incidence rate and epidemiology of cervical spinal injuries and management in tertiary care hospital of delhi: A institutional based retrospective study
Khushal Gupta, Rahul Bharadwaj, Bhupender Khatri, Loveneesh G Krishna
Department of Orthopaedics, Central Institute of Orthopedics, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India
|Date of Submission||30-Jan-2021|
|Date of Decision||15-Feb-2021|
|Date of Acceptance||20-May-2021|
|Date of Web Publication||21-Jul-2021|
Loveneesh G Krishna,
Central Institute of Orthopedics, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi
Source of Support: None, Conflict of Interest: None
Background: Cervical spine injuries were the most common problem nowadays that many people experiencing due to high-intensity trauma. In contrast, substantial heterogeneity and lack of data exist among clinical spine trauma epidemiological studies limiting the ability to compare and pool data. The most common mechanism of injury is usually motor vehicle accidents. However, its patient-centered characterisation and quantification are lacking. Materials and Methods: Incidence and characteristics of cervical spine injury were identified in the tertiary care hospital of Delhi. Fifty-six cervical spine injuries admitted patients among all 228 spinal trauma patients who presented in the orthopaedic trauma emergency registry were recruited in this study. Results: There were 56 subjects identified (8.53%) with cervical spine injury admitted per further evaluation. Among these, 85.7% were male. Mainly age group involve is 20–40 year (median age – 24 year), mostly injured by road traffic accident (RTA) (35.7%). The cervical injury commonly has upper, and subaxial vertebrae fractures and anterolisthesis are much common than retrolisthesis. The hospital stay of listhesis patient is usually more than disc bulge patients. Halovent application is more common in the upper cervical (c1–c2), like anterior cervical plating with dissectomy is common in disc bulge cervical patients. Conclusion: Cervical spinal injury is associated with RTA in the young age group. A head injury like trauma should take into consideration in every cervical patient. Early management with better operative techniques can decrease hospital stay and increase the recovery rate of patients.
Keywords: Fracture, road traffic accident, spinal cord injury, vertebrae
|How to cite this URL:|
Gupta K, Bharadwaj R, Khatri B, Krishna LG. Incidence rate and epidemiology of cervical spinal injuries and management in tertiary care hospital of delhi: A institutional based retrospective study. Adv Hum Biol [Epub ahead of print] [cited 2021 Oct 26]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=322144
| Introduction|| |
Spinal cord injury (SCI), a common occurrence in polytrauma, often affects young people and is a major cause of illness and poses high health care costs and significant threats to survival and quality of life.
Cervical spine injury is a common problem now in the days when most people experience it due to severe trauma. In India, cervical spine injuries that occur in the subcontinent occur as a result of falls on roofs falls on trees and mountain or in road accidents. The social and economic impact of cervical spine injuries is widespread, as most cervical spine injuries occur in adults. Epidemiological research can provide important details about their magnitude of this problem and potential demand in health care resources. Reliable and detailed descriptions of cervical spine injury patterns can ultimately facilitate the development of preventive measures and interventions that can increase injury detection.
While high heterogeneity and data shortages are among the clinical studies of spinal trauma that reduce the ability to compare and consolidate data, estimates of the prevalence of cervical trauma among all spinal trauma patients ranged from 33.7% to 53.7% according to the previous studies and showed high rates of M >F and 15–30 years of age. The most common mechanism of injury is usually motor vehicle accidents. However, its patient-centered formulation and quantification are lacking. Most people do not have medical insurance to cover medical expenses. It is therefore considered appropriate for a hospital analysis to take place after such an injury to determine the actual burden and its consequences to proceed with the planning of preventive measures, as well as the management process, in accordance with the procedure.
| Materials and Methods|| |
This study is a retrospective hospital-based analysis of spine-injured patients that presented to the Department of Orthopedics, Vardhaman Mahavir Medical College, Safdarjung Hospital, Delhi, India. 56 cervical spine injury of all levels admitted patients among all 228 spinal trauma patients who presented in orthopaedic trauma emergency registered were recruited in this study from January 2019 to June 2019.
Patients with a cervical spine injury, i.e., from C1 to C7 cervical vertebrae, are included. Data analysed included patient age, gender, associated injuries, level of injury, and sensory condition according to the American Spinal Injury Association Scale.
The cause, duration, method of operation, sensory level and severity of the injury, associated injuries, radiological/magnetic resonance imaging diagnostic problems, treatment details and results were obtained and analysed. Conservative management provided the condition of Skull traction reduction and initial stiffness of the cervical spine fractures, thoracic braces and lumbar traumatic SCI. Surgical procedures include laminectomy of vertebrae, internal cervical ancectomy and fusion (ACDF), Corpectomy, lateral mass fixation, Pedicle screw fixation.
Any improvement or deterioration in the degree of SCI during treatment and follow-up was recorded. All data are analysed using SPSS version 15. Ethical clearance has been taken from the ethical committee with Ethical no. (SJH2020/201).
| Results|| |
Our study showed that 656 spine encounters in the emergency unit from January 2019 to June 2019. There were 56 subjects identified (8.53%) with cervical spine injury admitted per further evaluation. Among these, 85.7% were male. Mainly age group involve is 20–40 year (median age – 24 year), mostly injured by road traffic accident (RTA) (35.7%). The cervical injury commonly has upper, and subaxial vertebrae fractures and anterolisthesis are much common than retrolisthesis. Bladder bowel is commonly associated with cervical cord injury (91%) [Table 1]. Meantime in days from DOI and DOA is 4 ± 1 day and from DOI to DOS* is 24 ± 1 days. The hospital stay of listhesis patient is usually more than disc bulge patients [Table 2]. Halovent application is more common in the upper cervical (C1–C2), like anterior cervical plating with dissectomy is common in disc bulge cervical patients [Table 3]. Complications of procedures are rare in cervical spine injury, with 2 cases among 56 (3.5%) having post-operative fistula formation [Table 4].
|Table 1: Distribution of patients according to demographic, cause and clinic-radiological parameters|
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|Table 2: Mean value of the time of patients stay in hospital from date of injury to date of treatment|
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| Discussion|| |
The epidemiology of cervical spine injury in a developing country assists with adequate treatment, rehabilitation of patients and efficient use of health care resources. Most medical documents come from developed countries where the problem and presentations vary in terms of injury, sex, and incidents. At an advanced medical facility, a patient with a spinal injury is removed from the injury site within 1 h. In developing countries, most patients receive treatment within 2–3 days or even weeks after a SCI.
Our study showed that 56 subjects were identified (8.53%) with a cervical spine injury. Of these, 85.7% were male. Mainly the age group includes 20–40 year (median age – 24 year) most affected by RTA (35.7%). The people of India have a bad knowledge of traffic laws, and poor road quality in the region are the main cause of high RTA in the world. Shamim et al. and Lalwani et al. concluded that the cervical spine was the most common site of SCI.
Another study by Kakadiya et al. established by the 31–45 age group had a high incidence (37.7%) of cervical spine injury. The average for men and women was 4.3:1. Road accidents (55.3%) were the most common cause of SCI, followed by a fall from a height (23.5%).
A study by Shrestha et al. showed that the most vulnerable age group most likely to be involved in cervical spine injury is 30–49 years. In a study by Singh et al. the male average (74.9%) to female (25.1%) was 2.98:1.
In the current study, 39 patients had other related injuries, with head injuries being the most common injury statistics with 28 cases (71.79%). Roopsingh et al. showed that the most common injuries associated with cervical spine injuries were head injuries (7%) followed by fracture fractures (6.3%), chest injuries (3.1%), abdominal injuries (0.9%) and pelvic injuries (0.7%). In a recent study by Singh et al. 75% of cases did not show CSI-related trauma. Other extremely related injuries were head injuries, followed by fractures, chest injuries, abdominal injuries and genital injuries.
Our study showed that the mean duration of days from the date of injury and date of admission is 4 ± 1 day and from the day of injury to the day of treatment is 24 ± 1 days. The hospital stay of a patient of listhesis (38 days in between) is usually more than the disc bulge patients (26.5 days average). Shamim et al. established long hospital stay (P value 14 0.006), it was associated with many complications, especially those related to infection (P value = 0.002) and had very high medical costs (P value = 0.001)) compared with the care group. Another study by Pandey et al. concluded his study following a typical 23-month follow-up revealed that 17% of patients who underwent spinal surgery had died, all of which had already happened.
Procedural complications are rare in cervical spine injury in 2 of the 56 (3.5%) cases of post-fistula formation in our study. Kakadiya et al. developed the most common pressure ulcer at 56 (16.5%) followed by urinary tract infection at 40 (11.8%).
| Conclusion|| |
We concluded that cervical spinal injury is associated with RTA in the young age group. When cord compression is present, they frequently affect bladder bowel functioning. A head injury like trauma should take into consideration in every cervical patient. Early management with better operative techniques can decrease hospital stay and increase the recovery rate of patients.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ahsan MK, Zaman N, Islam J. Management of spinal injuries in polytrauma patients: An experience of tertiary care hospital. Mymensingh Med J 2019;28:182-92.
Singh R, Sharma SC, Mittal R, Sharma A. Traumatic spinal cord injuries in haryana: An epidemiological study. Indian Journal of Community Medicine,2003;XVIII(4):184-186.
Gunby I. New focus on spinal cord injury. JAMA 1981;245:1201-6.
Tator CH, Duncan EG, Edmonds VE, Lapczak LI, Andrews DF. Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia 1995;33:254-62.
Torlincasi AM; Muhammad Waseem..Textbook “Cervical Injury” Treasure Island (FL): StatPearls Publishing; 2021.
Shafafy R, Valsamis EM, Luck J, Dimock R, Rampersad S, Kieffer W, et al.
Predictors of mortality in the elderly patient with a fracture of the odontoid process. Bone Joint J 2019;101-B:253-9.
Shamim MS, Ali SF, Enam SA. Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan. Surg Neurol Int 2011;2:166.
] [Full text]
Lalwani S, Singh V, Trikha V, Sharma V, Kumar S, Bagla R, et al.
Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India. Indian J Med Res 2014;140:40-5.
] [Full text]
Kakadiya G, Shakya A, Gandbhir V, Soni Y, Gohil K. Epidemiology and management of traumatic spine injuries at tertiary care hospital of India. Glob J Health Sci 2020;9:1-2.
Shrestha D, Garg M, Singh GK, Singh MP, Sharma UK. Cervical spine injuries in a teaching hospital of eastern region of Nepal; A clinic-epidemiological study. J Nepal Med Assoc 2007;46:107-11.
Manjeet S, Siddhartha S, Iftikhar W, Agnivesh T, Farid M, Nirdosh M, et al
. Spine injuries in a tertiary health care hospital in Jammu: A Clinico - Epidemiological Study. The Internet Journal of Neurosurgery. 2008;5(2):1-4
Pandey V, Nigam V, Goyal TD, Chhabra H. Care of post-traumatic spinal cord injury patients in India: An analysis. Indian J Orthop 2007;41:295-9.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4]