Presentation, management, and outcome of traumatic spine injuries in Africa: a systematic review and meta-analysis

Objective: Traumatic spinal injury (TSI) involves diverse etiologies, posing different risks among patient populations worldwide. Discrepancies in TSI treatment and outcomes between high-income countries and low- and middle-income countries highlight the critical necessity for tailored management approaches for this global challenge. This study delves into the presentation, management, and outcomes of TSI in Africa.

Methods: A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles describing spine trauma in Africa.

Results: In total, 105 articles comprising 74 retrospective/prospective studies and 31 case reports/series with 11,639 patients from 16 African countries were included. Among retrospective/prospective studies, most patients were male (8543/10,538 [81.1%]) with an estimated mean (95% CI) age of 34.5 (32.6-36.3) years. Mechanism of injury included road traffic accidents (RTAs) (mean [95% CI] 49.5% [42.9%-56.0%]) followed by falls (23.2% [18.21%-28.3%]), with most injuries occurring at the cervical spine level (51.6% [44.3%-58.9%]). Regionally, cervical, thoracic, and lumbar injuries were predominant in West (mean [95% CI] 58.6% [45.3%-70.9%]), Southern (54.4% [44.3%-63.9%]), and East (23.0% [11.9%-34.8%]) Africa, respectively. Mean (95% CI) time from injury to presentation was 60.8 (23.0-98.6) hours, and the mean distance to a healthcare facility was 272.6 (220.8-324.4) km (5 articles). Of the 48 articles detailing management approaches, approximately 31.9% (95% CI 21.7%-42.2%) opted for surgery, whereas 64.1% (53.7%-74.4%) pursued conservative treatment. Overall, clinical improvement was reported in 34.1% (95% CI 26.6%-41.6%) (44 articles) of patients at last follow-up, with an estimated mortality rate of 12.1% (9.3%-15.0%) (55 articles). Regionally, clinical improvement in patients was highest in Southern Africa (39.1% [95% CI] 23.2%-55.0%), whereas West Africa had the highest mortality rate (16.9% [10.7%-23.1%]).

Conclusions: The authors' review reveals that TSI in Africa is primarily caused by RTA. Significant challenges exist such as delays in access to care and surgical capacity. Regional differences in injury mechanisms, management, and outcomes exist and addressing these disparities through targeted interventions is pivotal to enhancing patient outcomes and reducing the burden of TSI in Africa.