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Nonoperative treatment of traumatic spinal injuries in Tanzania: who is not undergoing surgery and why?

TitleNonoperative treatment of traumatic spinal injuries in Tanzania: who is not undergoing surgery and why?
Publication TypeJournal Article
Year of Publication2020
AuthorsLessing NL, Lazaro A, Zuckerman SL, Leidinger A, Rutabasibwa N, Shabani HK, Härtl R
JournalSpinal Cord
Date Published2020 Apr 29
ISSN1476-5624
Abstract

STUDY DESIGN: Retrospective, cohort study of a prospectively collected database.

OBJECTIVES: In a cohort of patients with traumatic spine injury (TSI) in Tanzania who did not undergo surgery, we sought to: (1) describe this nonoperative population, (2) compare outcomes to operative patients, and (3) determine predictors of nonoperative treatment.

SETTING: Tertiary referral hospital.

METHODS: All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, fracture morphology, neurologic exam, indication for surgery, length of hospitalization, and mortality. Regression analyses were used to report outcomes and predictors of nonoperative treatment.

RESULTS: 270 patients met inclusion criteria, of which 145 were managed nonoperatively. Demographics between groups were similar. The nonoperative group was young (mean = 35.5 years) and primarily male (n = 125, 86%). Nonoperative patients had 7.39 times the odds of death (p = 0.003). Patients with AO type A0/1/2/3 fractures (p < 0.001), ASIA E exams (p = 0.016), cervical spine injuries (p = 0.005), and central cord syndrome (p = 0.016) were more commonly managed nonoperatively. One hundred and twenty-four patients (86%) had indications for but did not undergo surgery. After multivariate analysis, the only predictor of nonoperative management was sustaining a cervical injury (p < 0.001).

CONCLUSIONS: Eighty-six percent of nonoperative TSI patients had an indication for surgery. Nonoperative management was associated with an increased risk of mortality. Cervical injury was the single independent risk factor for not undergoing surgery. The principle reason for nonoperative management was cost of implants. While a causal relationship between nonoperative management and inferior outcomes cannot be made, efforts should be made to provide surgery when indicated, regardless of a patient's ability to pay.

DOI10.1038/s41393-020-0474-y
Alternate JournalSpinal Cord
PubMed ID32350408
PubMed Central IDPMC7222864