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Difficulties in the Management and Prognosis of Cervical Spine Trauma in a Regional Neurosurgery Unit in a Developing Country: The Example of Senegal

Authors:
  • Institut pasteur, Sénégal, Dakar
Acta Scientific Orthopaedics (ISSN: 2581-8635)
Volume 4 Issue 3 March 2021


Faye Mohameth1,2, Barry Louncény Fatoumata2*, Sy El Hadji Cheikh
Ndiaye2, Djasde Donald1, Roger Ilunga Mulumba1, Ndongo
Mouhamadou Moustapha1, Diop Abdoulaye2, Cisse Yakhya2, Mualaba
Célèbre2 and BA Momar Code2
1Neurosurgery Unit, Regional Hospital Center of Thies, Senegal
2Neurosurgery Department, Fann University Hospital, Dakar, Senegal
*Corresponding Author:


Received:
Published:
Barry
Louncény Fatoumata., et al.
Abstract
Introduction:       
 

Materials and methods:    

Results:      




Conclusion:

Keywords: 
Abbreviations
       
 


Introduction

 [1]   
         [2]  
       
[3]   
 
 

 
   


        
   
   

Citation: ., et al.



Example of Senegal
  
 

Material and Methods
 

   
 

 

         
 
     

Results
   


         

  
 
  
        




 

Etiologies Staff Percentage
  
  
 
  

        


        

       

  


 





     
  
 
      
 

 



Radiological injuries Staff
 lesions 12





2
4
1


 2

 
 1
 1
 
 1
 4
 


 

Citation: ., et al.



Example of Senegal
Figure 1




Figure 2




Figure 3
    
         


  
  


         
   
  

On admission Post-therapy
Frequency Percentage Frequency Percentage
  33 
B 20  13 
11  14 
D  10 
30   
  100 a100


a 


   

    
     



Discussion
     
   
    
     
         
Citation: ., et al.



Example of Senegal
         





         


  
[11]       




        
            
  
 

   

 

        
  

   [12]   
[13]
[14]
 

        


    
    
      

         
    
 


 
      







        
 

  
         
       


[20]

et al[21]et al[22]
et al[23]

et al[23]
    


       
        
     


   


    
  
        

Citation: ., et al.



Example of Senegal
Conclusion
         
   
 
       





       





Bibliography
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
2. 

3. et al   

European Spine Journal
4.  et al  
  

5. et al
 
Neurochirurgie
6.  et al  
-

7.         


8. 
 Ann Fr Anesth Réanim 23

9.  


10. et al 
 

11. et al 
American

12.  et al   
        South

13. West Af-

14. et al  



15.   et al    
Réanimation 
16. et al

17. et al
   

18.   et al      
       
       
Neurosurgery
19.   et al     
       
Journal of Trauma 
20. 
   

21. et al   
   Journal of Neurosurgery

22. et al
Neurosurgery Review
Citation: ., et al.

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
Example of Senegal
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23.   et al      
 

Citation: ., et al.
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To demonstrate the safety and utility of one surgical approach, the authors reviewed their experience with the ventral surgical approach for decompression, reduction, and stabilization in 10 patients with either unilateral or bilateral cervical facet dislocation. Six patients presented with unilateral cervical facet dislocation and four patients with bilateral cervical facet dislocation. There were six male and four female patients who ranged in age from 17 to 72 years (average 37.1 years). The level of facet dislocation was C4-5 in one, C5-6 in four, and C6-7 in five patients. Three patients presented with a complete spinal cord injury (SCI), three patients with an incomplete SCI, three with radicular symptoms or myeloradiculopathy, and one patient was neurologically intact. All patients underwent plain radiography, magnetic resonance imaging, and computerized tomography evaluation of the cervical spine. All patients had sustained significant ligamentous injury with minimum or no bone disruption. All patients underwent ventral decompressive surgery, reduction of the dislocation, and stabilization of the cervical spine. Techniques for performing ventral reduction of unilateral or bilateral cervical facet dislocation are described. Decompression, reduction, and stabilization of the cervical spine via the ventral approach was accomplished in all but one patient. This patient underwent a ventral decompressive procedure and an attempt at ventral reduction and subsequent dorsal reduction and fusion in which a lateral mass screw plate fixation system was used; this was followed by ventral placement of instrumentation and fusion. There were no surgery-related complications. Postoperative neurological status was unchanged in four patients and improved in six patients. No patient experienced neurological deterioration after undergoing this surgical approach. The authors conclude that a ventral surgical decompression, reduction, and stabilization procedure provides a safe and effective alternative for the treatment of patients with unilateral or bilateral cervical facet dislocation without significant bone disruption.
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This is a European cohort study on predictors of spinal injury in adult (≥16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8–64.0) and Injury Severity Score of 9 (IQR = 4–17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age <45 years (≥45 years OR 0.83–0.94), Glasgow Coma Score (GCS) 3–8 (OR 1.10, 95% CI 1.02–1.19), falls >2 m (OR 4.17, 95% CI 3.98–4.37), sports injuries (OR 2.79, 95% CI 2.41–3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83–2.00) were predictors for spinal fractures/dislocations. Age <45 years (≥45 years OR 0.78–0.90), male gender (female OR 0.78, 95% CI 0.72–0.85), GCS <15 (OR 1.36–1.93), associated chest injury (OR 1.10, 95% CI 1.01–1.20), sports injuries (OR 3.98, 95% CI 3.04–5.21), falls >2 m (OR 3.60, 95% CI 3.21–4.04), RTCs (OR 2.20, 95% CI 1.96–2.46) and shooting (OR 1.91, 95% CI 1.21–3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in >10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients <45 years, with a GCS <15, concomitant chest injury and/or dangerous injury mechanisms (falls >2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial. Electronic supplementary material The online version of this article (doi:10.1007/s00586-011-1866-7) contains supplementary material, which is available to authorized users.
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