The Epidemiological, clinical and therapeutic profile of surgical pathologies of the cervical spine at the Laquintinie Hospital in Douala

Abstract

The cervical spine can be the site of several lesions (traumatic, degenerative, tumoral, infectious, inflammatory or congenital). These pathologies are serious because of the neurological complications they cause. Their diagnosis is clinical, radiological and sometimes anatomopathological. The treatment of severe forms is surgical. These pathologies can be life-threatening, functional with some repercussions on society. The aim of our study was to describe the epidemiological, clinical and therapeutic profile of surgical pathologies of the cervical spine at the Laquintinie Hospital in Douala.

This is a cross-sectional study with retrospective enrolment from January 2010 to June 2016 and prospective enrolment from July 2016 to August 2016, a period of 6 years and 6 months at the Laquintinie Hospital in Douala, with 49 patients operated during the retrospective phase and 6 patients during the prospective phase, i.e. 55 patients aged 11 to 69 years with an average age of 40 years, 89.1% were male patients and 19.1% female patients, representing 10% of neurosurgery operations and 34% of all spine operations. 95.7% of patients were admitted by non-medical means and 5.3% by medical means. The aetiology was traumatic (85.5%) with 74.5% following a stroke, degenerative (7.3%), tumorous (5.5%) and infectious (1.8%). The reason for consultation was more marked by neck pain (37.5%) and the functional impotency of the limbs in 25%; the mode of onset was progressive (87.5%) and slow (12.5%); the symptomatology is more marked by neck pain (97.9%) and torticollis (16.4%); neurological signs (93.6%) are dominated by pain on mobilisation (83.6%) and central hyperthermia (45.5%).Stage A of the FRANKEL classification was the most frequent (32.7%) and head trauma (19.1%) was the most associated trauma. CT scans were performed in 85.5% of patients. The lesion was located in the C6C7 segment (27.3%) and was a fracture-luxation. The operating time was 16.8 days [5.3-28.3]. Osteosynthesis (25.5%) by anterior approach without scopy was the most used surgical technique with 25.5% of patients. In the short term, there were 5 revision surgeries (9%) and 5 infectious complications (9%). The average postoperative hospital stay was 12.6 days. Postoperative death was 18.2%. In the long term, postoperative satisfaction was good at 95.7%.

Pathologies of the cervical spine are dominated by trauma and concern the young subject. The clinic is dominated by incomplete spinal cord injuries. CT scans are mainly used. Osteosynthesis is the main therapeutic modality. Postoperative complications are rare and long-term postoperative results are satisfactory.