Anterior decompression, fusion and plating in cervical spine injury: Early experience in Abuja, Nigeria

SUBMITTED FOR PUBLICATION
ABSTRACT

Aims and Objectives

We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailed retrospective study on the surgical management of patients with cervical spine injuries from Nigeria.

Method

The medical reports of patients with traumatic cervical spine and spinal cord injuries undergoing surgery from 1st August 2009 till 30th August 2010 were reviewed. Management and early results of outcome were ascertained and detailed consecutively in a prospective Microsoft Office Access® database (Microsoft Group of Companies). Frankel grading was used for pre and immediate post operative evaluation (within 48 hours). The Barthel Index (BI) was used to classify patients as dependent or independent at follow-up.

Results

Twenty consecutive patients presented with acute cervical spine and spinal cord injuries since August 2009. 20 anterior cervical spine decompression and fixation with an iliac graft and an anterior cervical plate (ACDF) were performed in 18 patients. All operations were performed with general anaesthesia using standard techniques but without a microscope or a high speed drill. Of the 18 patients who were operated, 4 patients died within a short period following surgical intervention. 7 patients have made a full recovery and 7 remain fully dependent. Only two of the dependent quadriplegic patients have become reintegrated back into the society.

Conclusion

The management of spinal cord injuries in Abuja is evolving. The operations were performed adequately with much limited complement of equipment. The morbidity and mortality in this series is acceptable. Poor intensive care therapy is a major challenge and improvements in this area of care will likely lead to better patient outcomes.

Keywords

Trauma, Cervical Spine traumatic instability, Surgical fixation, Anterior cervical discectomy, Outcome, Nigeria

Comments:

The points to note is that these emergency operations can be performed in Nigeria to a satisfactory standard and achieving good results. Five of the patients went abroad (UK, SA and Beirut) for rehabilitation and none had to be re-operated by the reviewing neurosurgeons.

Patients with acute cervical spine injuries can be operated as soon as possible to decompress the spinal cord, re align the fractured bones and therefore ease them into rehabilitation early. Information is important and so YOU need to know that we have the facility to offer early intervention for your patients.

The days of bed rest for months while the doctor thinks about what to do are over, at least in Abuja. These operations reported here were performed safely with a minimum complement of equipments. We now of course, have additional equipments and have operated on many more patients who would be reported in the near future. 

Example below showing before and after surgery MRI scan images. The spinal canal has been opened up and the pressure off the spinal cord.

Another case: The chap had a complex fracture at C2/C3 and spinal cord contusion at C5/C6. He was operated at both levels with spinal screw fixation, anteriorly. Post operative image a few days later. On the right, in a wheel chair and active rehabilitation has commenced. He improved to walking and independent function within a few months after discharge to rehab in Gboko, Benue State. He is back to his previous employment.

This is what we are hoping to achieve in a consistent manner. Operating early allows the patient to go for rehab early and prevents bed sores, urinary/ chest infections, deep vein thrombosis, depression and early death.