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Problématique de la prise en charge des traumatismes graves du rachis cervical en pays sous-développé
Abstract
Introduction
Les traumatismes du rachis cervical sont fréquents. Leur prise en charge nécessite une approche multidisciplinaire basée sur la gestion des urgences et la rééducation. Dans notre contexte cette chaîne est défaillante, surtout sur le volet des soins de suite. Nous relevons dans cette étude les difficultés de la prise en charge de ces traumatisés à Dakar.
Patients et méthodes
Il s’agissait d’une étude rétrospective (2005–2009), portant sur 99 patients admis pour traumatisme grave du rachis cervical dans deux hôpitaux de Dakar. Les aspects cliniques, thérapeutiques et évolutifs ont été étudiés. Le recul variait entre trois et 54 mois.
Résultats
L’âge moyen des patients était de 36,1 ans avec comme principale étiologie les accidents de la voie publique (73,7 %). Le transport du blessé était médicalisé dans 65,7 % avec un délai moyen d’admission de 64,86 heures. À l’admission, 57,6 % des patients avaient un score de Frankel A ou B. Les luxations (59,6 %) et les fractures de type Tear drop (16,2 %) étaient les principales lésions. La chirurgie a été effectuée dans 83,8 %, après un délai d’attente moyenne de 128,84 heures après le traumatisme. La rééducation était essentiellement ambulatoire quel que soit le statut neurologique du patient. La récupération a été totale dans 20,2 % et partielle dans 31,3 % avec un taux de mortalité de 37,4 %. La plupart des décès survenait entre un et six mois (59,5 %) principalement due à des complications de décubitus (56,8 %).
Conclusion
L’efficacité de la prise en charge des traumatismes graves du rachis repose sur la réduction des délais préopératoires et sur la rééducation.
... They are complicated in 15 to 30% of cases of spinal cord injury [2,4]. The prognosis depends on the initial spinal cord injuries and the speed of treatment [5]. While upper cervical spinal cord injury is often life-threatening, lower cervical spinal cord injury can sometimes result in serious neurological sequelae that require a multidisciplinary medical and paramedical approach to avoid complications. ...
... While upper cervical spinal cord injury is often life-threatening, lower cervical spinal cord injury can sometimes result in serious neurological sequelae that require a multidisciplinary medical and paramedical approach to avoid complications. The final outcome is then the result of several factors, ranging from the efficiency of the spine trauma emergency management system to the rehabilitation structures [5]. In our context, this chain of care is deficient at various levels, especially in the areas of collection, transport and follow-up care, including rehabilitation with complications of often lethal decubitus. ...
... The vast majority of cervical rachis trauma affects young adults between 15 and 35 years of age, with an average age of 30 years [11], 35.7 years in our series and 36.1 years in the Dakar series [5]. The male predominance noted in our series is consistent with data from the literature [3][4][5]. ...
... L'âge moyen dans notre série est de 37,04 ± 19 ans. Kpelao et al. [10] au Sénégal avaient trouvé une moyenne de 36,1 ans. Motah et al. [11] dans une série globale des traumatismes vertébro-médullaires trouvaient une moyenne de 37 ± 17 ans. ...
... Cette tendance est rapportée de manière générale, faisant des traumatismes du rachis un problème de santé publique dans les pays en développement [12]. La prédominance masculine dans notre série (sex ratio de 3,55) est également retrouvée chez Kpelao et al [10], mais avec une plus forte proportion de 9/1. Loembe et al. [13] au Gabon trouvaient une prédominance masculine à 84% sur les données d'une étude menée sur la période de 1981 à 1994. ...
... Loembe et al. [13] trouvaient une fréquence de 67,5%. Kpelao et al. [10] trouvaient 73,7%. Cette fréquence amène à suggérer qu'un renforcement des conditions de régulation routière pourrait permettre de réduire la fréquence globale des traumatismes du rachis. ...
Introduction. The aim of this study was to assess the management of traumatic cervical spine injuries in the University Hospital Center of Brazzaville.
Methods. This was a cross sectional descriptive study, during January 2014 to December 2015, in the University Hospital Center of Brazzaville. We included all patients admitted for cervical spine trauma, excluding those with surgery associated with another lesion other than the cervical spinal. The parameters evaluated were anthropometric, clinical, radiologic, therapeutic and evolutive.
Results. 41 patients met the inclusion criteria. Their mean age was 37.04 ± 19 years and the sex ratio H/F was 3.55. Cervical spine injuries were due to road accident in 78.04% of cases. At the initial examination, 31.71% of patients were in the A class of American Spinal Injury Association (ASIA). CT-scan was obtained for 39 patients (95.12%) and MRI for four patients (9.75%). Subaxial luxations were the more frequent lesion. Surgery was performed to 19 patients (46.34%). It consisted mainly of arthrodesis by anterior approach. Evolution was favorable for 19 patients (46.34%). The most frequent complications were genito-sphincteral disturbances, severe bedsore and infections. Nine patients (21.95%) died.
Conclusion. Cervical spine injuries are frequent and potentially serious at Brazzaville. The prevention involves mainly road traffic regulation. CT-scan is essential for the management. Prognosis depends on initial clinical assessment.
... In our study, the crush due to various reason was the most incriminated like etiology of cervical spine trauma, it's appeared in 46,34% of case whose 26,82 % occur at home, at literature, 55,55% according to Quenum study [10] in 2011. The duration between the trauma and the hospitalized taken care is still clearly superior compared to developed countries like France [11], but can be compared to the others African countries as in Senegal 64-86h [12], 10h in south Africa [13] and 2,5 days in Nigeria [14]. In our study 43, 90% of patients were asymptomatic; 31, 7% of deficit patients whose 17, 07% had severs deficit Frankel A and 14, 63% Frankel B. A result which differ from literature, in fact according to the study done by Kpelao in 2013 in Senegal [12] 36, 4 % Frankel A and 21, 12% Frankel B. The simple standard radiography of cervical spine is fulfilled in 85, 61% of case and the scanner which was the imagery through excellence demanded in 23, 02%, the only patient could profit of MRI so we could not do exactly the diagnosis of medullary contusion which is the MRI diagnosis [15,16]. ...
... The duration between the trauma and the hospitalized taken care is still clearly superior compared to developed countries like France [11], but can be compared to the others African countries as in Senegal 64-86h [12], 10h in south Africa [13] and 2,5 days in Nigeria [14]. In our study 43, 90% of patients were asymptomatic; 31, 7% of deficit patients whose 17, 07% had severs deficit Frankel A and 14, 63% Frankel B. A result which differ from literature, in fact according to the study done by Kpelao in 2013 in Senegal [12] 36, 4 % Frankel A and 21, 12% Frankel B. The simple standard radiography of cervical spine is fulfilled in 85, 61% of case and the scanner which was the imagery through excellence demanded in 23, 02%, the only patient could profit of MRI so we could not do exactly the diagnosis of medullary contusion which is the MRI diagnosis [15,16]. The interest of a standard radiography is less important especially in the unconscious patients according to the study of Robert in 2002 [17]. ...
The cervical spine trauma is a frequent and serious lesion involving not only the vital prognostic but also functional. The target of this work was to determinate the epidemiological clinical profile and the issue related to the management of cervical spine traumatism in Madagascar. It was the 3 years retrospective works with 41 cases of the cervical spine trauma hospitalized and supported in a department of neurosurgery and resuscitation at CHU-JRA Antananarivo Madagascar. We included all patients’ records for traumatized cervical spine and incomplete files have been excluded. While the targeted period, 41 cases of the cervical spine trauma has been studied, 24, 39% of traumatized was between 21-30 years old with a clear male predominance of 80, 48% (sex ratio 4, 1). The etiology is dominated by a fall and the majority was of domestic accident (46,34%). The cervical wounded was part of polytrauma, 58, 53 % of the case are brain injury. Clinically, 39, 02% of the patients were tetraplegic and the standard radiograph represented the requested radiological tool in 82.92%. The mortality rate was 21, 95%. The cervical spine trauma remains pathology difficult to manage because of the respiratory risk which requires a managing in reanimation and the prognostic vital is reserved for complete quadriplegics.
... The degenerative pathology came third (6.29% of patients). This difference with some authors of the literature could be related to the small size of our sample but also to the duration of the study [16][17][18]. No patient had to be operated on. ...
... Also, there is a patient who has worsened clinically postoperatively operated for cervical spine trauma. Our results are below those of some authors who found an overall mortality of 8.9% to 37.4% [2,[16][17][18][19][20]. This could be related to the size of the sample. ...
Objective: To define the epidemiological profile of the neurosurgical activity of hospitalized patients. Patients and methods: We conducted a descriptive retrospective study from January 2018 to August 2019 (18 months) in the neurosurgery department of the Loandjili General Hospital in Pointe Noire, including patients hospitalized for a neurosurgical condition. The parameters evaluated were epidemiological, diagnostic, therapeutic and progressive. Results: 214 patients were hospitalized during the study period of which 143 cases were included in our study. The average age of our patients was 37.9 years with a sex ratio of 1.8 and a mortality of 28.85%. Traumatic pathology accounted for 81.11% of cases. Conclusion: Neurosurgical conditions remain a major public health problem. Neuro-traumatic emergencies remain the main activity of our service. There is an interest in setting up teams that are competent and equipped to improve the management of patients.
... The associated lesions were mainly cranial in 24.48% of cases, in a cohort study done by Bouyer in France in 2011 [7], 30% of traumas were in the context of a polytrauma. The length of time between trauma and hospital care remains much higher compared to developed countries such as France [12], and can be compared to other African countries, namely 64-86h in Senegal [13], 10h in South Africa [14]. ] and 2.5 days in Nigeria [15]. ...
Thoracolumbar spine injury is a frequent and serious lesion with functional prognosis. The objective of this study was to determine the epidemiological-clinical profile and the therapeutic aspects of thoracic and lumbar spine injuries in Madagascar. This was a retrospective, single centered 3-years study of 98 cases of thoracic and/or lumbar spine trauma hospitalized and managed in the neurosurgery department at Joseph Ravoahangy Andrianavalona Antananarivo Madagascar University Hospital center. During the targeted period, 98 trauma cases were studied, of which 24.39% of the traumatized were between 21 and 30 years old with a clear male predominance of 80.48% (sex ratio 4.1). Etiology is dominated by a drop in 36.72% of cases. It was part of a polytrauma that included head trauma in 58.53%. Clinically, 39.02% of the patients were tetraplegic and the standard radiograph represented the requested radiological tool in 82.92%. The mortality rate was 21.95%. Thoracic and lumbar spine injuries are serious and several Frankel A type neurological deficits are usually irreversible despite rapid management
... Kpelao et al. (9) ont identifié à Dakar (Sénégal) 99 patients porteurs d'un traumatisme du rachis cervical, dont 83,8% de patients opérés, avec une mortalité globale (opérés et non opérés) de 37,4%. Les chiffres de mortalité peuvent ainsi être améliorés par des mesures de prévention routière car la gravité clinique initiale influence lourdement le pronostic. ...
RESUME Objectif Présenter et discuter des résultats de l'activité neurochirurgicale au Centre Hospitalier Universitaire (CHU) de Brazzaville. Patients et Méthode Nous avons réalisé une étude rétrospective de janvier 2014 à septembre 2015 (21 mois), incluant les patients hospitalisés pour affection neurochirurgicale. Les examens neuroradiologiques disponibles étaient le scanner et l'IRM. Les paramètres évalués étaient épidémiologiques, diagnostiques, chirurgicaux et évolutifs. Résultats 403 patients ont été hospitalisés durant la période d'étude dont 224 cas pour 2014. L'âge moyen était de 46 ans, un sex-ratio de 2,03 et une mortalité de 17,23%. Les traumatismes (crâniens et vertébro-médullaires) et les affections dégénératives du rachis étaient les plus fréquents en milieu hospitalier (54,35% et 11,9%) ainsi que dans la série des cas opérés. L'évolution postopératoire était favorable dans 70,56% des cas. Nous avons enregistré 7,53% de cas d'infections postopératoires. La mortalité postopératoire était de 8,9% des cas. Conclusion La pratique neurochirurgicale est facilitée par la vulgarisation du scanner et de l'IRM. Les résultats sont encourageants dans l'ensemble de notre série. L'amélioration de la prise en charge nécessite un servicespécifiquement dédié à la neurochirurgie, l'amélioration du plateau technique et une nécessaire coopération multidisciplinaire. ABSTRACT Objective To present and discuss the neurosurgical practice at the university hospital of Brazzaville. Patients and Method We conducted a retrospective study from January 2014 to September 2015 (21 months), for all patients who have been hospitalized for neurosurgical diseases. CT-Scan and MRI were performed for management of patients. The studied parameters were epidemiological, diagnostic, surgical and dynamically evolving. Results 403 patients were hospitalized during our study. The average age were 46 years and the sex ratio 2.03 and the mortality, 17.23%. Neurotraumatology and degenerative spine diseases were frequently observed-respectively 54.35% and 11.9%-in the serie of surgical cases. Post-surgical evolution was favorable in 70.56%. 7.53% of the patients had post-surgical infections and the mortality 8.9%. Home Journal Archives Informations for Authors Downloads Editorial Board Links PAANS 22/11/2016 [AJNS-African Journal of Neurological Sciences] http://ajns.paans.org/article.php3?id_article=508 2/6 Conclusion Access to CT-scan and MRI have facilitated the neurosurgical practice. Our results are encouraging. The treatment's conditions need an improvement of our technical environment, a ward dedicated to neurosurgery and a multidisciplinary cooperation.
RESUME Objectif: Décrire les lésions retrouvées à l'Imagerie par Résonnance Magnétique (IRM) chez les traumatisés du rachis cervical et thoracique à Cotonou. Méthodologie : Étude rétrospective sur une durée de 12 mois; de janvier 2017 à décembre 2017; réalisée à l'unité d'IRM du CRES/IRM de Cotonou. Étaient inclus tous les traumatisés du rachis cervical et thoracique adressé en IRM. Étaient exclus tous les patients dont le dossier radiologique n'a pas été retrouvé dans le système d'archivage du centre. Les paramètres étudiés étaient: l' âge et le sexe, l'indication clinique de l'IRM et les lésions retrouvées. Résultats: Trente-trois dossiers ont été colligés. L'âge moyen était de 44,6 ans ± 13,20 avec des extrêmes de 24 et 78 ans. Il y avait une prédominance masculine avec une sexe ratio de 3,71. L'accident de la voie publique était la cause de tous les traumatismes du rachis. 75,75% des indications d'IRM l'ont été dans le cadre d'un déficit neurologique aigu post traumatique. Vingt-sept patients présentaient des lésions traumatiques vertébro-médullaires. La localisation principale des ces lésions était le rachis cervical inférieur dans 67% des cas. Les lésions retrouvées étaient isolées ou associées. Ces lésions étaient osseuses dans 16 cas, discales dans 19 cas, ligamentaires dans six cas, une avulsion du plexus brachial droit et 22 lésions médullaires. 16 lésions médullaires avaient un mauvais pronostic à l'IRM. Conclusion: Les lésions médullaires traumatiques étaient fréquentes, graves et de mauvais pronostic neurologique. L'IRM a permis un bilan précis des atteintes traumatiques médullaires et extramédullaires. ABSTRACT Objective: To describe the lesions found in traumatized cervical and thoracic spine in Cotonou. Methodology: Retrospective study over a period of 12 months; from january 2017 to december 2017; was performed at the MRI unit of CRES / MRI in Cotonou. Included subject was any traumatized cervical and thoracic spine referred for MRI. Excluded subject was any patient whose radiological record was not found in the archiving system of the center. The parameters studied were: age and sex, clinical indication of MRI, lesions founded. Results: Thirty-three cases were collected. The average age was 44.6 years ± 13,20 with extremes ranging from 24 to 78 years. There was a male predominance with a sex ratio of 3.71. Public road accident was the cause of the trauma. The post-traumatic acute neurological deficit was the main indication for MRI (75.75%). We found traumatic vertebromedullary lesions in 27 patients. The main site of these lesions was the lower cervical spine in 67% of cases. Lesions have been isolated or associated. These lesions were bony in 16 cases, discal in 19 cases, ligamentous in six cases, one avulsion of the right brachial plexus and 22 spinal cord injuries. 16 spinal cord injuries had a poor prognosis on MRI. Conclusion: Traumatic spinal cord injury was frequent, severe, and had a poor neurological prognosis. MRI allowed a precise assessment of traumatic medullary and extramedullary lesions.
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