Sub-cervical spinal injuries with neural involvement. The Ga-Rankuwa Hospital experience.

A retrospective analysis of 48 patients with injuries of the thoracic and lumbar spine and with neural involvement showed that motor vehicle accidents (62.5%) and a fall from a height (20.8%) were the most common causes of injury. T11-L2 was the segment of the spine most commonly affected, accounting for 70% of all vertebral injuries. Associated, non-spinal injuries, frequently severe, were present in 50% of patients. There were 27 complete and 14 incomplete spinal cord injuries; of the cauda equina lesions, 3 were complete and 4 incomplete. Surgical reduction and stabilisation with dual Harrington distraction rodding, supplemented by sublaminar wiring, was performed in 85% of patients. Surgery reduced the period of obligatory bed-rest by half, but shortened the mean time in hospital by only 2.4 weeks (16%). Surgery did not appear to promote neurological recovery and no patient deteriorated neurologically in the course of treatment. Four out of 7 patients treated non-surgically improved neurologically, as did 14 out of 41 who underwent surgery. Ultimately, 17 patients became ambulatory, with or without walking aids. The Harrington rodding system as used was found to be reliable without additional external bracing. Dislodgement of hooks occurred in 7 patients. These all occurred as a result of judgmental or technical error and should be entirely preventable.