Demographic Profile of Traumatic Spine Injuries at a Level 1 Trauma Center of Eastern India: A Retrospective Study

Abstract

Background Trauma is a leading cause of hospitalization worldwide, with spinal injuries resulting from traumatic events having severe and lasting repercussions. The high incidence of these injuries places a significant burden on families and health care systems. Disparities in epidemiological findings often occur due to the location- or culture-specific factors. This study aims to address the inadequate attention given to morphological patterns and their impact on neurological damage severity, which affects functional outcomes over time.

Objectives The main objective of this study was to identify the injury patterns and detect associated spinal or extraspinal injuries in traumatic spine injury (TSI) patients who visited a level 1 trauma care facility in eastern India. Additionally, it aimed to establish a correlation between the severity, morphology, and grades of neurological damage with demographic characteristics.

Materials and Methods This retrospective cross-sectional study was conducted at the neurosurgery unit of the trauma and emergency department (TED) at a level 1 trauma center in eastern India. It involved TSI patients admitted between March 15, 2023, and March 14, 2024. Data were collected from paper-based records and compiled into a structured Excel format. The study included adult patients admitted to the TED with traumatic spinal cord injuries and excluded those from outpatient departments or those with incomplete data. Data analysis utilized the Muller AO classification, Injury Severity Score (ISS), and ASIA classification, with statistical analysis performed using IBM SPSS version 19.0.

Results Out of 320 patients, 309 met the inclusion criteria. The majority were males (263) with a median age of 39 years. Falling from a height (43.7%) was the most common mechanism of injury, followed by road traffic accidents (37.9%). Polytrauma was present in 73% of patients, with multilevel injuries more severe than single-region injuries. Type A fractures were most common (53.4%), and 67.6% of patients underwent surgery. A significant correlation was found between the ISS and ASIA scores.

Conclusion The study revealed differences in spinal injury epidemiology in eastern India compared to other regions, with multiple vertebral level injuries being more common. The findings highlight the need for government health care strategies focused on treatment and rehabilitation, especially for the younger age group that is predominantly affected. Preventive measures should also be strictly enforced to reduce the incidence of such injuries.

Keywords

American Spinal Injury Association (ASIA) classification - eastern India - epidemiology - level 1 trauma center - morphological patterns - neurological damage - polytrauma - road traffic accidents - traumatic spine injuries

Publication History

Article published online:
30 December 2024

• References

• 1 World Health Organization.. Injuries and Violence: The Facts. Geneva: World Health Organization; 2014
• 2 Kumar R, Lim J, Mekary RA. et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg 2018; 113: e345-e363
• 3 Leucht P, Fischer K, Muhr G, Mueller EJ. Epidemiology of traumatic spine fractures. Injury 2009; 40 (02) 166-172
• 4 Lomaz MB, Netto LA, Filho MS, Alves AP, De Tavares Canto FR. Epidemiological profile of patients with traumatic spinal fracture. Coluna/Columna 2017; 16: 224-227
• 5 Aleem IS, DeMarco D, Drew B. et al. The burden of spine fractures in India: a prospective multicenter study. Global Spine J 2017; 7 (04) 325-333
• 6 Singh G, Prakash R, Bhatti V, Mahen A. Spinal cord injury in organizational setup: a hospital based descriptive study. J Mar Med Soc. 2019; 21: 46-50
• 7 Birua GJS, Munda VS, Murmu NN. Epidemiology of spinal injury in north east India: a retrospective study. Asian J Neurosurg 2018; 13 (04) 1084-1086
• 8 Akmal M, Trivedi R, Sutcliffe J. Functional outcome in trauma patients with spinal injury. Spine 2003; 28 (02) 180-185
• 9 Bouyer B, Vassal M, Zairi F. et al. Surgery in vertebral fracture: epidemiology and functional and radiological results in a prospective series of 518 patients at 1 year's follow-up. Orthop Traumatol Surg Res 2015; 101 (01) 11-15
• 10 Schousboe JT. Epidemiology of vertebral fractures. J Clin Densitom 2016; 19 (01) 8-22
• 11 den Ouden LP, Smits AJ, Stadhouder A, Feller R, Deunk J, Bloemers FW. Epidemiology of spinal fractures in a level one trauma center in the Netherlands: a 10 years review. Spine 2019; 44 (10) 732-739
• 12 Singh R, Sharma S, Mittal R, Sharma A. Traumatic spinal cord injuries in Haryana: an epidemiological study. Indian J Community Med 2003; 13: 184-186
• 13 Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3 (04) 184-201
• 14 Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma 1988; 28 (01) 69-77
• 15 Kirshblum SC, Waring W, Biering-Sorensen F. et al. Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med 2011; 34 (06) 547-554
• 16 Jain M, Sahu RN, Behera S, Rana R, Tripathy SK, Pattnaik A. Standalone instrumented posterior approach used as universal approach for tuberculosis spondylodiscitis. J Neurosci Rural Pract 2019; 10 (02) 225-233
• 17 Elgin LB, Appel SJ, Grisham D, Dunlap S. Comparisons of trauma outcomes and injury severity score. J Trauma Nurs 2019; 26 (04) 199-207
• 18 Mathur N, Jain S, Kumar N, Srivastava A, Purohit N, Patni A. Spinal cord injury: scenario in an Indian state. Spinal Cord 2015; 53 (05) 349-352
• 19 Wang H, Zhang Y, Xiang Q. et al. Epidemiology of traumatic spinal fractures: experience from medical university-affiliated hospitals in Chongqing, China, 2001-2010. J Neurosurg Spine 2012; 17 (05) 459-468
• 20 van Asbeck FW, Post MW, Pangalila RF. An epidemiological description of spinal cord injuries in the Netherlands in 1994. Spinal Cord 2000; 38 (07) 420-424
• 21 Kiwerski JE. The causes, sequelae and attempts at prevention of cervical spine injuries in Poland. Paraplegia 1993; 31 (08) 527-533
• 22 Iida H, Tachibana S, Kitahara T, Horiike S, Ohwada T, Fujii K. Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma 1999; 46 (03) 450-452
• 23 Calenoff L, Chessare JW, Rogers LF, Toerge J, Rosen JS. Multiple level spinal injuries: importance of early recognition. AJR Am J Roentgenol 1978; 130 (04) 665-669
• 24 Choi SJ, Shin MJ, Kim SM, Bae SJ. Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI. Korean J Radiol 2004; 5 (04) 219-224