Spectrum of Clinical Presentation of Cervical Spinal Cord Injury in Ado-Ekiti
Keywords:
Cervical spinal cord injury, clinical presentation, mortality predictors, NigeriaAbstract
Background: Cervical spinal cord injury (CSCI) is a devastating condition associated with significant morbidity and mortality, particularly in low- and middle-income settings where pre-hospital care and trauma systems are often suboptimal. Understanding the clinical spectrum and determinants of outcome is essential for improving management strategies.
Objective: To evaluate the spectrum of clinical presentation and identify predictors of mortality among adult patients with cervical spinal cord injury in Ado-Ekiti.
Methods: This was a hospital-based prospective descriptive and analytical study conducted over an 18-month period between July 2024 and December 2025 and involved 43 adult patients with confirmed cervical spinal cord injury. Data were collected using a structured proforma for capturing socio-demographic characteristics, injury mechanisms, clinical presentation, radiological findings, management, complications, and outcomes. Neurological status was assessed using the ASIA impairment scale. Data were analyzed using descriptive statistics and multivariate logistic regression to identify predictors of mortality, with statistical significance set at p < 0.05.
Results: The majority of patients were males (72.1%), with the peak age group being 18–30 years (27.9%). Road traffic accidents were the leading cause of injury (65.1%), with motorcycle-related incidents predominating. Most patients presented late, with over half presenting after 24 hours, and 67.4% received no pre-hospital care. Clinically, neck pain (81.4%), limb weakness, and severe neurological deficits such as quadriparesis (46.5%) and quadriplegia (41.9%) were common. Complete spinal cord injury (ASIA A) was observed in 32.5% of patients. The mortality rate was 18.6%, while only 23.2% achieved functional independence at discharge. Independent predictors of mortality included complete injury (aOR = 6.85, p = 0.006), upper cervical level involvement (aOR = 4.92, p = 0.019), respiratory difficulty (aOR = 5.63, p = 0.014), and delayed presentation beyond 24 hours (aOR = 3.76, p = 0.048).
Conclusion: Cervical spinal cord injury in Ado-Ekiti predominantly affects young males and is largely due to preventable causes such as road traffic accidents. The clinical presentation is often severe, with a high burden of neurological deficits and complications. Mortality is significantly associated with injury severity, higher cervical involvement, delayed presentation, and respiratory compromise. Strengthening pre-hospital care, promoting early presentation, and improving acute management may enhance outcomes.
References
World Health Organization, International Spinal Cord Society. International Perspective on Spinal Cord injury. WHO; 2013.
Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology. Spinal Cord. 2014; 52(2): 110–116.
Kumar R, Lim J, Mekary RA, et al. Traumatic spinal injury: global epidemiology and worldwide volume. Spine. World Neurosurgery 2018; 133: e345-e363.
Michael G Fehlings, Lindsay Tretreault, Jefferson R. Wilson, et al. A Clinical Practice Guideline for the Management of Acute Spinal cord Injury; Introduction, Rationale and Scope. Global Spine Journal. 2017; 7(3S): 84S-94S
DeVivo MJ. Epidemiology of traumatic spinal cord injury. Spinal Cord. Ttrends and future implications. 2012; 50(5): 365–372.
Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury. : what learns a worldwide literature survey? Spinal Cord. 2006; 44(9): 523–5299.
Chiu WT, Lin HC, Lam C, et al. Epidemiology of traumatic spinal cord injury: Comparisons Between Developed and Developing Countries. Asia pacific Journal of Public Health. 2010; 22(1); 35(20): E1199–205.
Obalum DC, Giwa SO, Adekoya-Cole TO, Enweluzo GO. Profile of spinal injuries in Lagos, Nigeria. Spinal Cord. 2009; 47(2): 134–7.
Nwankwo OE, Uche EO. Epidemiological and treatment profiles of spinal cord injury in Southeast Nigeria. Spinal Cord. 2013; 51(3): 448–52.
Solagberu BA. Spinal cord injuries in Ilorin, Nigeria. West Afr J Med. 2002; 21(3): 230–2.
Alfin JD, Shilong DJ, Bot GM, et al. Clinical profile and predictors of Early outcome in Patients with Traumatic spinal cord injury in Jos, J West Afr Coll Surg. 2023; 13(2): 45–52.
Rupp R, Biering-Sørensen F, Burns SP, Graves DE, Guest J, Jones L, Read MS, Rodriguez GM, Schuld C, Tansey-Md KE, Walden K, Kirshblum S. International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019. Top Spinal Cord Inj Rehabil. 2021; 27(2): 1-22.
Uche EO, Nwankwo OE, Okorie E, Nnezianya I. Cervical Spine Injury: A ten-year multicenter analysis of evolution of care and risk factors for poor outcome in southeast Nigeria. Niger J Clin Pract 2015; 18: 203-8.
Adigun TA, Sanusi AA, Idowu OK. Outcome of Traumatic Cervical Spinal Cord Injury in a General ICU: A 5-Year Review. Arch Med. 2020; 12(4): 15.
Mohammed MA El-Beshbeshy, Mohammed G Hassan, Al-Moataz A Zohney, Mohammad M El-Sharkawi. Profile of Traumatic Cervical Spine Injuries in Assiut University Hospital. Egy Spine J. 2020; 35: 53-60.
Middleton JW, Dayton A, Walsh J, et al. Life expectancy after spinal cord injury. Spinal Cord. 2012; 50(11): 803–11.
Scott L. Zuckerman, Arsalan Haghdel, Noah L. Lessing, Joseph Carnevale, Beverly Cheserem, Albert Lazaro, Andreas Leidinger, Nicephorus Rutabasibwa, Hamisi K. Shabani, Halinder Mangat, Roger Hartl. Cervical Spine Trauma in East Africa: Presentation,Treatment, and Mortality. International Journal of Spine Surgery. 2021; 15 (5): 879–889.
Jain NB, Ayers GD, Peterson EN, et al. Traumatic spinal cord injury in the United States, 1993-2012. JAMA. 2015; 9; 313(22): 2236–43.
Chhabra HS, Arora M. Demographic profile of traumatic spinal cord injuries admitted at Indian Spinal Injuries Centre with special emphasis on mode of injury; a retrospective study. Spinal Cord 2012; 50(10): 745–54.
Winslow C, Rozovsky J. Effect of spinal cord injury on respiratory function. Am J Phys Med Rehabil. 2003; 82(10): 803–14.
Mock C, Kobusingye O, Joshipura M, et al. Strengthening trauma and critical care globally. Curr Opin Crit Care. 2005 Dec;11(6):568-575.
Thanni LOA, Kehinde OA. Trauma care at a Nigerian Teaching Hospital : Pattern and Documentation of Presentation. African Health Sciences. 2006; 6: 104-107.
Garber SL, Rintala DH, Hart KA et al. Pressure ulcers in spinal cord injury: predictors of ulcer status over 3 years. Arch Phys Med Rehabil. 2000; 81(4): 465-471.
Waites KB, Canupp KC, DeVivo MJ Epidemiology and risk factors for Urinary tract infection following spinal cord injury. Arch Phys Med Rehabil.1993;74(7): 691-5.
Hagen EM, Rekand T, Gilhus NE, Gronning M. Traumatic spinal cord injuries-incidence, mechanisms and course. Tidskr Nor Legeforen. 2012;132(7): 831-7.
Wilson JR, Grossman RG, Blessing NR, et al. Natural History, Predictors of Outcome, and Effects of Treatment in Thoracic spinal cord injury: A Multi-Center Cohort study from the North American Clinical Trials Network. Journal of Neurotrauma. 2018; 35: 2554-2560.
