Traumatic Cervical Spine: Epidemiological, Anatomo-Clinical And Therapeutic Aspects Of 81 Cases Collected In Nouakchott-Mauritania

Research Article
Ahmed Ould El Moctar., El Bou Ould Isselmou Boukhary., Ahmed Salem Ould Kleib., Med Mahmoud Sidi Mohamed., Aminata Ndiaye., Sidi Elhaj Ould Dah., Sidi MD Ould Salihy and Outouma Soumaré
DOI: 
http://dx.doi.org/10.24327/ijrsr.2018.0903.1714
Subject: 
science
KeyWords: 
Cervical spine trauma, tetraplegia, osteosynthesis, arthrodesis, corporectomy
Abstract: 

Introduction: Cervical spine injuries are all bone and / or disco-ligamentous lesions of the cervical spine, with or without neurological disorders following trauma. They are serious because of the neurological consequences that bring into play the vital and functional prognosis. Management of cervical spine trauma should be early to avoid neurological complications. Objectives: to bring back the experience of our service in the care. Methodology: This is a retrospective study of 81 cases of cervical spine trauma collected in Nouakchott, Mauritania between August 1, 2015 and January 07, 2018. Results: In our study hospital prevalence was 0.4%, the mean age was 42 years, with extremes of 12 to 73 years, with a male predominance of 69 cases, or 85.2%, with a sex ratio of 5 , 75, 12cas female, or 14.8%. 57 cases, that is 70.3% represented the accident victims of the public road, 15 cases, 18.5% of the accidents of work, 7cas that is 8.6% of the domestic accidents and 02 cases, or 2.5% of sports accidents. According to the clinic 46 cases, 56.8% had incomplete tetraplegia, 14 cases, 17.3% complete tetraplegia, 16 cases, or 19.7% of radicular syndrome and 05 cases, ie 6.2% of Brown Sequard syndrome. We found an injury level at C6 level in 32 cases (39.5%), a C7 level in 13 cases (16%), a C5 level in 10 cases (12%), a C3 level in 10 cases (12%) , a C2 level in 07 cases (8.6%), a C4 level in 05 cases (6%), and a C8 level in 04 cases (5%) 57 cases (70.3%) found had as mechanisms lesions a hyper flexion, 15 cases (18.5%) by compression, 07cas (8.6%) by rotation and 02 cases (2.5%) of hyper flexion. CT was performed in 79 cases (97.5%) and MRI in 28 cases (34.5%), and a standard radiograph in 50 cases (62%). Orthopedic treatment was recommended in 17 cases (21%) and surgical treatment in 64 patients (79%), which consisted of: anterior C5-C6 arthrodesis in only one case and in front of bilateral, it was realized a double approach; posterior initially allowing the reduction of dislocation and anterior with C7-D1 arthrodesis. Anterior osteosynthesis for a C7-D1 dislocation: one of our patients had a posterior approach to reduction and fixation with 02 plates and four C5-C6 trans-articular screws. A bilateral C5-C6 dislocation fracture operated posteriorly, in one case a corporectomy with two-level plate and iliac graft plate arthrodesis was used. A teardrop C5 fracture with recoil of the posterior wall; anterior bi segmental arthrodesis and corporectomy C5. A fracture of the odontoid Alonzo II requiring anterior screw fixation. We noted in the 81 cases, 16 cases (19.7%) of deaths were noted of which 09 cases (11.11%) before the treatment and 07 cases (8.64%) after the surgery. Conclusion: Cervical spine injuries are serious and pose an economic and social problem. They bring into play the vital and functional prognosis. CT and / or MRI should be performed as first-line and as early as possible for early management to ensure free marrow and stable spine.