Spinal Cord Compression in Togo: Etiologies and Management

Abstract

Spinal cord compression etiology depends on geographic region. In sub-Saharan Africa, the etiologies are mostly infectious, and management is characterized by diagnostic delay and limited treatment modalities. In Togo, treatment was nonoperative until 2008. However, management has improved with the development of imaging and availability of specialists. We sought to report etiology and outcome of spinal cord compression since establishment of a neurosurgery unit in Togo. A retrospective descriptive study was performed of patients admitted for spinal cord compression in the neurosurgery unit of a referral hospital in Togo between 2008 and 2018. Follow-up was conducted at 3, 6, and 12 months after discharge. Spinal cord compression represented 4.2% of hospitalizations. Median patient age was 41 years; 5 patients were children. Men accounted for 64.6% of patients. Patients presented late to the hospital; 40.7% reported symptoms lasting >1 year. Claudication was the presenting symptom in 75.2%. At presentation, 20.3% of patients had complete neurological lesions. The main etiology of compression was degenerative disease. Surgery was performed in 81.4% of patients; only 16.3% were operated on within 72 hours of admission. Chemotherapy was administered in 5 cases. At 1 year after surgery, 33.7% of patients had total neurological recovery, and 50% had partial recovery. Factors influencing neurological recovery were age, initial neurological status, and type of treatment. This study found increased degenerative causes of spinal cord compression in Africa. The pathology is characterized in our context by late consultation and operative delay affecting recovery, morbidity, and mortality.