Spinal cord injury epidemiology and prognosis, single institution study from the Eastern Black Sea Region

Introduction: In this study, we aimed to present the epidemiological and clinical data of patients with spinal cord injuries or traumatic vertebral fractures who were operated on in our hospital, and to identify etiological factors and high-risk groups. Materials and Methods: Between January 2012 and October 2023, a retrospective analysis was conducted on 650 patients who were admitted to or referred to our hospital due to spinal trauma and subsequently underwent surgery. Data collected included the year, month, and season of surgery, age, gender, duration of stay in the service and intensive care unit, reason for hospital admission, reoperation status and its cause, type of injury, spinal injury region and vertebral level, type of vertebral fracture, accompanying additional traumatic pathologies, acute mortality rate and functional group according to the ASIA classification. During this period, the hospital records maintained during the patients'hospitalization and the data obtained from periodic routine check-ups were reviewed. Results: Of the patients, 60% (n=390) were male and 40% (n=260) were female, with a male-to-female ratio of 1.5:1. The median age was 53 years, with an average age of 50.11 ± 18.68 years. The average length of stay in the service was 7.48 ± 7.3 days, while the average length of stay in the intensive care unit was 11.47 ± 16.46 days. The years with the highest number of operations were 2020 and 2022, each with 66 patients (10.2%). The season with the highest operation rate was summer, at 35.8% (n=233). August was the month with the highest operation rate, at 13.5% (n=88). The most frequently operated age group was 46-55 years, accounting for 20.6% (n=134) of the patients. The most common reason for hospital admission was falls from height, at 47.8% (n=311). Reoperation was necessary in 14.2% (n=92) of the patients. Central cord syndrome developed on the basis of a narrow canal in 1.8% (n=12) of the patients, and 0.9% (n=6) had a traumatic disc without vertebral injury. The thoracic vertebrae were the most frequently injured vertebrae, accounting for 33.27% (n=219) of the injuries. At the level of individual vertebrae, the highest injury rate was seen in L1 vertebrae at 17.5% (n=115). In the cervical vertebrae, dislocation was the most common injury at 13.4% (n=87), while compression fractures were most common in the thoracic and lumbar vertebrae, at 17.2% (n=112) and 17.1% (n=111), respectively. Traumatic thoracic pathologies were the most common additional injuries accompanying spinal injuries. Following thoracic pathologies were orthopedic pathologies at 21.8% (n=142) and crush syndrome at 12.5% (n=81). Of the patients, 41.2% (n=268) were operated on within the first 24 hours after trauma. The decision for surgical approach favored the posterior approach in 89.2% (n=579) of the cases. At the initial examination following admission, 54.6% (n=355) of the patients had normal sensory and motor functions (ASIA E), while 11.4% (n=74) had complete spinal injury (ASIA A). At the most recent neurological examination, the ASIA A rate was 10.8% (n=70), the ASIA B, C, D rate was 33.2% (n=214), and the ASIA E rate was 56.3% (n=366). The mortality rate during the hospital follow-up period was 3.7% (n=24). When comparing the ASIA scores before surgery and at the last examination, there were no significant differences in age distribution and timing of surgery between the groups with improvement and those with deterioration or no change in the ASIA score (p > 0.05). When surgical approaches were evaluated, the intensive care unit (ICU) stay in the combined approach group was significantly longer than that in the anterior and posterior approach groups (p < 0.05). However, there was no significant difference in ICU stay between the anterior and posterior approach groups (p > 0.05). There were no significant differences in age groups, gender distribution, and vertebral injury region between patients who underwent wound revision or abscess drainage and those who did not (p > 0.05). Conclusion: A significant portion of spinal cord injuries actually stemmed from preventable causes. Examining the epidemiological, clinical, and demographic characteristics of these injuries will allow for the identification of the most common etiological factors and risk groups, enabling the implementation of preventive measures at both individual and societal levels. Keywords: Spinal cord injury, trauma, epidemiology.