Spinal Trauma Classification According to Its Anatomical Level and the Spinal Cord Injury

Abstract

Introduction The spinal trauma (ST) presents 82.8% in men around 32 years' old; the 56.5% has spinal cord injury (SCI), whose word incidence is 25.5 million/year. The main cause is traffic accidents. In Colombia, 55% of ST are cervical and 45% has complete SCI. Overall, 80 to 85% are men between 20 to 30 years' old and 25% is related to alcohol consumption. The American Spinal Injury Association (ASIA) classifies the SCI in: (1) complete sensitive and motor function; (2) incomplete: normal sensibility, no motor function (MF); (3) incomplete: MF under the lesson less than 3/5; (4) incomplete: MF more than 3/5; and (5) normal. Spine divides itself in upper cervical: C0–C2 (UCS), low cervical C3–C7 (LCS), thoracic, and lumbar. Objectives This study aims to classify the ST according its place, SCI, and surgical treatment. This study also characterizes the population under surgery by ST; establish its level, describe the SCI associated with ST, and stablish the surgical treatment according the level of the ST. Patients and Methods Retrospective, analytic, and descriptive study, using the clinical registers. Patients were admitted in the emergency of “Clínica de la Unidad de la Sabana” (CUS). Both sexes, no age limit age, between January 2009 and July 2014, who suffered spine arthrodesis caused by ST. Those who did not need surgery were excluded. The collection data form included the following: identification number, age, sex, level of the ST, SCI according ASIA scale, and surgical treatment. The data were analyzed in a descriptive and comparative way. Results The population comprised of 60 patients, 46 men and 14 women. The more frequent age was the second decade of life (17 patients, 11 M:6 W), followed by the third one (14 patients, 11 M:3 F). The principal segment affected was the cervical (24 patients: 5 UCS and 19 LCS), followed by lumbar (22 patients). The most frequent place was L1 (13) and C6–C7 (10). There were 29 patients with SCI ASIA A, 10 with ASIA E, and 21 patients with incomplete SCI. The lesions in the UCS did not have SCI; in the LCS were 15 ASIA A, 2 in ASIA E, and 2 incomplete SCI; thoracic had 10 ASIA A, 1 ASIA E, and 3 incomplete SCI, lumbar had 4 ASIA A, 2 ASIA E, and 16 incomplete SCI. The surgeries performed in the UCS were one 360 degrees arthrodesis, four posterior arthrodesis (PA), LCS: 6 corpectomy, 13 PA; thoracic and lumbar: 14 and 22 PA, respectively. Conclusion In our study, 76.6% were male patients, 51.6% were between the second and the third decade of life, as reported in the literature. Overall, 40% of the ST was cervical, a little lower than reported nationally, 48.33% had SCI ASIA A, very similar to the word statistics. The relation of the ST and SCI reported that the group with the highest SCI ASIA A was the LCS (78.94%) and thoracic (71.4%), the incomplete SCI was more frequent in the lumbar spine (72.7%), and the UCS has no SCI. The most frequent surgical approach was the posterior, in 88.3% of patients.