Mortality following surgical management of traumatic sub-axial cervical spine injuries in a South African tertiary centre.

OBJECTIVES

To evaluate 30-day mortality and survival up to five years post injury in surgically treated adults with traumatic sub-axial cervical spine injuries at a South African tertiary centre.

METHODS

We performed a retrospective observational study of adults who underwent surgery between 2018 and 2022. Mortality data were obtained from the South African Medical Research Council death registry. Primary outcomes were 30-day mortality and survival up to five years post injury. Univariable logistic regression was used to evaluate factors associated with 30-day mortality, and categorical ASIA-based logistic models were constructed to minimise overfitting. Cox proportional hazards analysis was used to evaluate predictors of survival during follow-up.

RESULTS

Eighty-six patients were included. Thirty-day mortality was 12%. Kaplan-Meier estimated overall survival was 83.7% at 1 year and 80.0% at 5 years. Seventeen patients died during follow-up. Univariable analysis identified spinal shock, ASIA grade, Injury Severity Score, and lower respiratory tract infection as factors associate with 30-day mortality. In time-to-event analysis, ASIA grade on arrival was the only factor independently associated with survival. Respiratory failure caused all but one death.

CONCLUSION

ASIA grade strongly predicted survival in traumatic sub-axial cervical spine injuries. Despite high mortality among patients with severe neurological injury, many patients survive, underscoring the importance of rehabilitation and community reintegration.