Article Sidebar
Main Article Content
Abstract
RÉSUMÉ
Introduction. Les traumatismes vertébro-médullaires représentent un défi diagnostique et thérapeutique en l’absence de système de sécurité sociale. Leur prise en charge est complexe avec un coût global important. Le but de cette étude a été de décrire les aspects diagnostiques, thérapeutiques et l’évolution des patients opérés. Patients et méthode. Il s’agissait d’une étude descriptive de cohorte prospective sur une période de 6 mois. Étaient inclus tous les patients admis aux urgences pour traumatisme du rachis dans les hôpitaux universitaires de référence de Yaoundé. Résultats. La fréquence des traumatismes vertébro-médullaires était de 3,7% des admissions aux urgences. Le sex-ratio homme/femme était de à 2,1. L’âge médian était de 39,7 ± 14,2 ans. Les accidents de la voie publique (60,3%) constituaient la principale étiologie. Le délai médian de référence était de deux jours. Deux tiers des patients étaient admis avec un déficit neurologique et parmi eux un tiers présentaient un syndrome sous lésionnel complet. Les traumatismes du rachis cervical représentaient 69,1%. Tous les patients opérés de grade C et D selon Frankel ont récupéré sur le plan neurologique. La mortalité à 30 jours était de 16,2%. Conclusion. Les patients admis en urgence pour traumatismes vertébro-médullaires sont jeunes. La moitié des patients présente des déficits neurologiques sévères et le rachis cervical est le segment le plus atteint. La chirurgie se rapproche des normes standards et la mortalité est élevée dans les formes sévères. Les soins de réhabilitation fonctionnelle restent encore difficiles.
ABSTRACT
Introduction. Traumatic spinal injuries represent a diagnostic and therapeutic challenge in our environment lacking of social security. Their management is complex and expansive. The aim of this study was to describe diagnostic, treatment and outcome of operated patients. Patients and Method. This was a descriptive cohort prospective study during six months. All patients with spinal injury admitted in the emergency department of the university teaching hospitals of Yaounde were included. Results. The frequency of traumatic spinal injury was 3.7% of all the emergency admissions. Male/female sex ratio was 2.1. The median age was 39.7±14.2 years. Road traffic accident (60.3%) was the main cause. The median time reference was two days. Two third of patients were admitted with neurologic deficit; among them one third presented with complete lesion syndrome. Cervical spinal injury represented 69.1% of cases. All Frankel’s grade C and D operated patients have had a neurologic improvement. Mortality at 30 days was 16.2%. Conclusion. Patients admitted with spinal injury at the emergencies were young. Half of them presented with severe neurologic deficit and cervical spine was the most touched. Surgical procedures attempt the standard norm and mortality is high in severe form. Rehabilitation cares are still difficult in our environment.
Article Details
References
- Pirouzmand F. Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. J Neurosurg Spine. 2010 Jan 19;12(2):131–40.
- Hagen E, Rekand T, Gilhus N, Grønning M. Traumatic spinal cord injuries – incidence, mechanisms and course. Tidsskr Den Nor Legeforening. 2012;132(7):831–37.
- GBD 2016 Traumatic brain injury and spinal cord injury collaborators. Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the global burden of diseases study 2016. Lancet Neurol 2019 ;18(1):56-87.
- Beavogui K, Koïvogui A, Souare IS, Camara D, Cherif M, Dramou B, et al. Profil des traumatismes crânio-encéphalique et vertébro-médullaire liés aux accidents de la voie publique en Guinée. Neurochirurgie. 2012 Oct;58(5):287–92.
- Kpelao E, Diop A, Beketi K, Tine I, Thioub M, Thiam AB, Ba MC. Problématique de la prise en charge des traumatismes graves du rachis cervical en pays sous-développé. Neurochirurgie. 2013 Jun;59(3):111–14.
- Frielingsdorf K, Dunn RN. Cervical spine injury outcome - A review of 101 cases treated in a tertiary referral unit. South African Medical Journal.2007;97(2): 203-07.
- Djientcheu VP, Njamnshi AK, Dongmo L. Epidemiology and management of injuries to the spine and spinal cord in the Yaounde Central Hospital: The need for a more concerted effort. Health Sciences and Disease 2001; 2 (June). 5–10.
- Feng H-Y, Ning G-Z, Feng S-Q, Yu T-Q, Zhou H-X. Epidemiological profile of 239 traumatic spinal cord injury cases over a period of 12 years in Tianjin, China. J Spinal Cord Med. 2011 Jul 1;34(4):388–94.
- Selvarajah S, Hammond ER, Haider AH, Abularrage CJ, Becker D, Dhiman N, et al. The Burden of Acute Traumatic Spinal Cord Injury among Adults in the United States: An Update. J Neurotrauma. 2013 Oct 18;31(3):228–38.
- Hua R, Shi J, Wang X, Yang J, Zheng P, Cheng H, et al. Analysis of the causes and types of traumatic spinal cord injury based on 561 cases in China from 2001 to 2010. Spinal Cord. 2013 Mar;51(3):218–21.
- Draulans N, Kiekens C, Roels E, Peers K. Etiology of spinal cord injuries in Sub-Saharan Africa. Spinal Cord. 2011 Dec ;49(12) :1148–54.
- Mathieu MM, Ndoumbe A, Kuate C, Youngui BT, Sende CN, Djientcheu VP. Prise en charge pré-hospitalière des patients victimes de traumatisme vertébro-médullaire en milieu africain. Heal Sci Dis. 2014;15(2):1-4.
- Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, et al. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J. 2011 Dec 1;20(12):2174–80.
- Ahidjo KA, Olayinka SA, Ayokunle O, Mustapha AF, Sulaiman GA, Gbolahan AT. Prehospital transport of patients with spinal cord injury in Nigeria. J Spinal Cord Med. 2011 May 1;34(3):308–11.
- Fehlings MG, Vaccaro A, Wilson JR, Singh A, W. Cadotte D, Harrop JS, et al. Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS ONE. 2012 Feb 23;7(2):32-37.
- Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of Decompressive Surgery of Spinal Cord after Traumatic Spinal Cord Injury: An Evidence-Based Examination of Pre-Clinical and Clinical Studies. J Neurotrauma. 2009 Dec 14;28(8):1371–99.
References
Pirouzmand F. Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. J Neurosurg Spine. 2010 Jan 19;12(2):131–40.
Hagen E, Rekand T, Gilhus N, Grønning M. Traumatic spinal cord injuries – incidence, mechanisms and course. Tidsskr Den Nor Legeforening. 2012;132(7):831–37.
GBD 2016 Traumatic brain injury and spinal cord injury collaborators. Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the global burden of diseases study 2016. Lancet Neurol 2019 ;18(1):56-87.
Beavogui K, Koïvogui A, Souare IS, Camara D, Cherif M, Dramou B, et al. Profil des traumatismes crânio-encéphalique et vertébro-médullaire liés aux accidents de la voie publique en Guinée. Neurochirurgie. 2012 Oct;58(5):287–92.
Kpelao E, Diop A, Beketi K, Tine I, Thioub M, Thiam AB, Ba MC. Problématique de la prise en charge des traumatismes graves du rachis cervical en pays sous-développé. Neurochirurgie. 2013 Jun;59(3):111–14.
Frielingsdorf K, Dunn RN. Cervical spine injury outcome - A review of 101 cases treated in a tertiary referral unit. South African Medical Journal.2007;97(2): 203-07.
Djientcheu VP, Njamnshi AK, Dongmo L. Epidemiology and management of injuries to the spine and spinal cord in the Yaounde Central Hospital: The need for a more concerted effort. Health Sciences and Disease 2001; 2 (June). 5–10.
Feng H-Y, Ning G-Z, Feng S-Q, Yu T-Q, Zhou H-X. Epidemiological profile of 239 traumatic spinal cord injury cases over a period of 12 years in Tianjin, China. J Spinal Cord Med. 2011 Jul 1;34(4):388–94.
Selvarajah S, Hammond ER, Haider AH, Abularrage CJ, Becker D, Dhiman N, et al. The Burden of Acute Traumatic Spinal Cord Injury among Adults in the United States: An Update. J Neurotrauma. 2013 Oct 18;31(3):228–38.
Hua R, Shi J, Wang X, Yang J, Zheng P, Cheng H, et al. Analysis of the causes and types of traumatic spinal cord injury based on 561 cases in China from 2001 to 2010. Spinal Cord. 2013 Mar;51(3):218–21.
Draulans N, Kiekens C, Roels E, Peers K. Etiology of spinal cord injuries in Sub-Saharan Africa. Spinal Cord. 2011 Dec ;49(12) :1148–54.
Mathieu MM, Ndoumbe A, Kuate C, Youngui BT, Sende CN, Djientcheu VP. Prise en charge pré-hospitalière des patients victimes de traumatisme vertébro-médullaire en milieu africain. Heal Sci Dis. 2014;15(2):1-4.
Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, et al. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J. 2011 Dec 1;20(12):2174–80.
Ahidjo KA, Olayinka SA, Ayokunle O, Mustapha AF, Sulaiman GA, Gbolahan AT. Prehospital transport of patients with spinal cord injury in Nigeria. J Spinal Cord Med. 2011 May 1;34(3):308–11.
Fehlings MG, Vaccaro A, Wilson JR, Singh A, W. Cadotte D, Harrop JS, et al. Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS ONE. 2012 Feb 23;7(2):32-37.
Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of Decompressive Surgery of Spinal Cord after Traumatic Spinal Cord Injury: An Evidence-Based Examination of Pre-Clinical and Clinical Studies. J Neurotrauma. 2009 Dec 14;28(8):1371–99.