EPIDEMIO-CLINICAL PROFILE OF CERVICAL SPINE TRAUMA AT CHU-JRA MADAGASCAR

Abstract

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.

Full text

EPH - International Journal Of Medical And Health Science
ISSN (Online): 2456-6063
Volume 05 Issue 03Auguest2019
DOI: https://doi.org/10.53555/eijmhs.v5i3.82
EPIDEMIO-CLINICAL PROFILE OF CERVICAL SPINE TRAUMA AT CHU-JRA
MADAGASCAR
Joseph Synèse Bemora1*, ToroHeryTsitovah Rakotondrainibe2, Patrick Rakotozanany3, Willy Francis
Rakotondraibe4, Willy Ratovondrainy5, Mamiarisoa Rabarijaona6, Clément Andriamamonjy7
*1257Department of Neurosurgery:University Hospital Center Joseph Ravoangy Andrianavalona (CHU-JRA) Madagascar
3Department of Neurosurgery: University Hospital Center of Soavinandriana Antananarivo Madagascar
6Department of Neurosurgery: University Hospital Center of Fianarantsoa Madagascar
*Corresponding Author:-
Email:-josbemora@yahoo.fr
Abstract:-
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.
Key words: cervical spine trauma, brain injury, polytrauma, tetraplegia.
Copyright 2019 EIJMHS
Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS
Volume-5 | Issue-3 | Aug, 2019
23

INTRODUCTION
Cervical spine trauma is a frequent pathology [1,2] with medullary involvement encountered in 15 to 30 percent of case
[3,4]. The cervical spine lesions represented 2 to 3 % of all trauma [5,6]. The prognosis depends on the initial lesions
medullary and the speed of their management. The cervical spinal trauma is severe lesion which can compromise the
functional prognosis and often vital of wounded [7]. The cervical spine lesions can reach the bones structures, articulars,
neurovascular, but mostly capsulo-ligament. The target of this work was to determinate the epidemiological and clinical
profile and the problematic related to charging of cervical spinal trauma seen at University Hospital Center Joseph
Ravoangy Andrianavalona (CHU-HJRA) Antananarivo Madagascar.
Materials and Method
It was a monocentric retrospective work and managed on hospitalized patient and taken care in the neurosurgery
department and reanimation at CHU-JRA to a cervical spinal trauma during a period of 3 years from July 2012 to July
2015. Our research is focused on the complete files of all hospitalized patient and taken care to a cervical spinal trauma
with or without lesion to imaging, the incomplete files have been excluded. The parameters studied were: the
epidemiology, clinic, paraclinical examination, treatment, evolution. Our principal means of diagnosis was the standard
radiography.
Results
During the target period, we have gathered 41 cases of traumatized patient of cervical spine trauma. They have been
observed mostly for the patient young male in 80,48% with 4,1 sex ratio and 27,6 average age.
Table I: Distribution of patient according to the age.
Age Number
(n=41)
Percentage
(%)
0 à 10 2 4,87
11 à 20 3 7,31
21 à 30 10 24,39
31 à 40 8 19,51
41 à 50 7 17,07
51 à 60 6 14,63
< 60 5 12,19
The trauma etiology was variable (table II), the crash by various reason which the domestic accident was the most accused
(46,34%) followed up by traffic accident (36,58 %).
Table II: Distribution according to the traumatism etiology
Trauma etiologic Number
(n=41)
Percentage
(%)
Crush 19 46,34
Traffic Motorist
accident
12 29,26
Motorcyclist 2 4,87
Walker 1 2,43
Sports Accident 4 9,73
Work Accident 2 4,87
Aggression 1 2,43
The risk factor are represented by the taken of alcohol (14,63%) and the excess speed (4,87%). The associated lesion were
essentially cranial in 58,53% of case followed by thoracic lesions 12,19 % and a limb fracture in 2,43%. The time limit
between the trauma and the hospitalized taking care was variable with an average duration from 1 to 5 days in 24,39% of
case. (Figure 1)
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24

Figure 1: Distribution according to the duration between the trauma and the hospitalized taking care
The mechanism of a lesion are dominated by the axial compression (46, 34%) due to the crash (Table III).
Mechanism Number (n=41) Percentage (%)
Axial
compression
19 46,34
Hyperextension 15 36,58
Hyperflexion 5 12,19
Rotation 1 2,43
Others 1 2,43
The victims have been transported by a personal car in 39, 02 %, a taxi (29, 26 %), an airplane (7, 31 %), an ambulance
(2, 38%) ET the rest (21, 95 %) by various means.
On the clinic plan, 43, 90% of patients were asymptomatic, 14, 63% only had a simple swarming. For the deficit patients
of the motor plan, we have remarked 1 case of BrownSéquard syndrome and 39, 02 % of tetraplegic patient who were
classified according to FRANKEL classification (Table IV). 43, 90% of patients (18 cases) have shown a sphincter
disorder.
Table IV: Motor deficit Classified by Frankel’s Classification
Classification of
Frankel
Numbers Percentage
(%)
A 7 17,07
B 6 14,63
C 2 4,87
D 1 2,38
Our diagnosis mean was essentially a simple standard radiography of cervical spine fulfilled in 85, 61% of case and a
cervical scanner in 23, 02 %, the cervical MRI was only fulfilled in 0, 71 % of case. Over the realization of a radiological
assessment, 21, 95% of case was normal and the rest, one or many lesions associated have been remarked (Table V). The
93, 75 % of visualized lesions were sitting in grade of inferior cervical spine against 6, 25% of superior segment affected.
Table V: Lesions objectified at imaging of the cervical spine
Lesions objectified Number Percentage (%)
Luxation-fracture 13 42,62
Corporeal fracture 7 21,87
Rectitude 7 21,87
Luxation 4 12,25
Rotation 1 3,12
Medullar contusion 1 3,12
0
1
2
3
4
5
6
7
8
9
10
Min à3011À 5 6 À 10 h À 24 h11 1 À5
Day À106
Day
>
10 days
Volume-5 | Issue-3 | Aug, 2019 25

Face to the secondary respiratory disorder apparition, 11 cases (26, 82%) require a management in reanimation and
transferred either in pre or post-operatory. The surgery is specified in 26, 81 % of patients and the technic used varied
according to the lesion type pathological (5 cases).
For the patients who had a motor deficit (16 cases), 23,52 % have a complete improvement, 23,52 % a partial improvement
and 52,94 % without improvement, which the most died of respiratory disorder with a mortality rate around 21,95% of
cases and the majority was tetraplegia.
Discussion
Male predominance and the young is demonstrated as well in our study as in literature [8, 9]. 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 interest
of a standard radiography is less important especially in the unconscious patients according to the study of Robert in 2002
[17]. The rapidity of performing a decompression-type surgical procedure plays a role directly in the prognosis of patients
[18]. In the most of cases, it is a pathology that involves not only the functional prognosis [19] but especially vital (8.63
% of deaths) with respiratory disorder [20, 21]. On global mortality, our study is similar to the literature, indeed in sub-
Saharan Africa the mortality rate varies between 7 and 35% [2, 22-25].
Conclusion
The cervical spine trauma is serious and poses a public health problem because of the burden imposed by deficit patients,
especially tetraplegia. The reduction between the duration of the trauma and the hospital care especially the achievement
of a surgery is primordial. Its pathology difficult to manage because of the risk of attack respiratory requiring a
management in the intensive care unit and life threatening is reserved for tetraplegia. In developing African countries such
as Madagascar, the management of traumatized cervical spine remains difficult given the inadequate technical platform.
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