Presentation, Management and Outcome of Traumatic Spine Injuries in Africa: A Systematic Review and Meta-Analysis

Introduction: Traumatic spinal cord injuries (TSCI) are a global concern, with road traffic accidents being a significant cause. High-income countries have made progress in improving outcomes through trauma networks. However, resource limitations in low- and middle-income countries result in higher mortality rates. This study aims to investigate TSCI mechanisms, clinical features, and management in Africa.

Methods: A systematic review was conducted using PubMed/MEDLINE, Google Scholar, and SCOPUS according to the PRISMA guidelines to analyze patient demographics, treatment strategies, and clinical outcomes.

Results: 83 retrospective/prospective studies and 32 case reports were included, covering 12,449 patients. Among the 32 case reports detailing 47 patients, the male-to-female ratio was 2.6:1. Common presenting symptoms included neck pain (34.04%) and sensory deficits (36.17%). ASIA grades at admission were distributed as follows: ASIA-A (4), ASIA-C (1), ASIA-D (1), ASIA-E (1). Road traffic accidents (53.19%), violence-related injuries (17.02%), and falls (12.77%) were the main injury mechanisms. Diagnosis primarily relied on X-rays (65.96%), CT scans (63.83%), and MRI (31.91%). The cervical spine was most affected (74.47%), followed by the lumbar spine at 10.64%, and the thoracic spine at 8.51%. Of the 47 patients, 27 (57.5%) underwent surgery, while 28 (59.57%) were managed conservatively. Nine initially managed conservatively eventually required surgery. The most common management approach was posterior (55.56%). Out of the patients, 22.22% underwent PCLF, 14.81% had PLIF, and 25.93% received ACDF. Post-operative complications included motor and sensory deficits in 8 cases (29.63%) and pressure ulcers in 3.70%. 74.47% of cases showed improved neurological status, with a documented 16.6% improvement in preoperative ASIA grade. The overall mortality rate was 4.26%.

Conclusion : TSCI, often associated with road traffic accidents, presents a global challenge. Disparities in care and outcomes between high-income and low- and middle-income countries highlight the need for improved strategies in Africa.