Consequences of Delayed Surgical Treatment of Traumatic Spinal Cord Injuries: Tertiary Centre Experience

Abstract

Introduction: Owing to its disabling consequences, spinal cord injury is devastating for both patients and their healthcare providers. There are many causes of spinal cord injury, the most common by far being motor vehicle accident (MVA). Unfortunately, in neglected injuries, many complications and poor outcomes could be encountered. This research aimed to assess the causes, consequences, and outcomes of neglected traumatic spinal cord injuries. Methodology: Out of the 750 cases reviewed between February 2016 and February 2021, 18 cases matched our inclusion criteria which was any Traumatic Spinal Cord Injury (TSCI) with neurological deficit requiring surgical intervention more than 14 days from the index trauma. The following variables were measured: patients’ demographics, injury, management, delay, complication, and hospital course characteristics. American Spinal Injury Association (ASIA) Impairment Scale scores were recorded at presentation and final follow-up. Result: Out of the 18 neglected TSCI patients, 72.2% were male. Patients’ mean age at the time of injury was 36.8 years, and 77.8% of them were from outside Riyadh. The mechanism of injury was MVA in all patients. Delay in referral to a tertiary hospital was the main cause accounting for 88.9%. The mean duration of neglect was 43 days. Improvement in ASIA score was found in two patients. Bedsores and DVT were found in 55.5% and 27.8%, respectively. Postoperatively, 77% of the patients were admitted to the ICU. Most patients (12) were unable to join a specialized spinal cord injury rehabilitation center postoperatively. Conclusion: Early referral of all traumatic spinal cord injury patients is highly encouraged to prevent short- and long-term complications.