Journal Article

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

Bohjanen, Paul R., Katabira, Elly T., Boulware, David R., Meyer, Ana Claire L., Minja, Frank, Meya, David B., Musubire, Abdu K.

2019

Overview

Background A few reliable national data concerning the etiology of non-traumatic spinal cord injury (SCI) in sub-Sahara Africa exists, mainly because of the limitations of diagnostic imaging. These are both expensive and mostly unavailable in several resource-limited settings. Only a few studies have employed the magnetic resonance imaging (MRI) in documenting non-traumatic SCI and most of these studies are from South Africa. We sought to describe the clinical presentation, MRI radiological patterns, and one-year survival among subjects with non-traumatic SCI in Uganda. Methods We enrolled a prospective cohort of 103 participants with non-traumatic SCI at Mulago National Referral Hospital Kampala, Uganda in 2013–2015. Participants received standard of care management, with surgical intervention as needed, with one-year follow up. Data were analyzed using Descriptive statistics. Results In 103 participants with non-traumatic SCI, the median (IQR) age was 37 (18, 85) years and 25% of the participants were HIV-infected. Paraplegia/paraparesis was the most common clinical presentation in 70% ( n  = 72). Severe disease was present in 82% ( n  = 85) as per American Spinal Injury Association (ASIA) scale A-C. On MRI, 50% had extradural lesions. However, bone lesions accounted for only 75% of all the extradural lesions. More than 60% of the patients had lesions that could only be diagnosed on MRI. Deaths occurred in 42% ( n  = 44) of participants, with the highest mortality among those with extradural lesions (60%). Conclusion The mortality following non-traumatic spinal cord injuries in Uganda is high. We demonstrated an equal distribution between extradural and intradural lesions, which differs from the historical predominance of extradural lesions. Increased utilization of MRI particularly among young age groups is needed to make a diagnosis.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Age / Aged / Aged, 80 and over / Bone lesions / Data processing / Diagnosis / Diagnostic imaging / Epidemiology / Etiology / Etiology (Medicine) / Female / Health aspects / HIV / HIV patients / Hospitals / Human immunodeficiency virus / Humans / Injuries / Magnetic Resonance Imaging / Male / Medical care quality / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / Mortality / MRI / Myelopathy / Neurochemistry / Neurocritical care / Neurology / Neurosurgery / NMR / Non-traumatic spinal cord injury / Nuclear magnetic resonance / Paralysis / Paraplegia / Patient outcomes / Prospective Studies / Research Article / Spinal cord injuries / Spinal Cord Injuries - diagnostic imaging / Spinal Cord Injuries - epidemiology / Studies / Sub-Saharan Africa / Uganda / Uganda - epidemiology / Young Adult / Young adults