Traumatic spinal cord injury in northern Nigeria: Cautionary notes about falls from Baobab/ Ebony Trees.
Shobode MA, Abubakar K, Mamman M, Waheed TA, Ekundayo OO, Onuminya JE, Abubakar MK, Salami AAO,
Address for correspondence:
Dr MA Shobode
Department of Clinical Services
National Orthopaedic Hospital, Dala, Kano, Nigeria
Background: Road traffic injury accounts for over 60% of the patho-mechanics of spinal cord in our environment. Authors have reported falls from palm tree in parts of Nigeria. Due to the threats of deforestation in parts of northern Nigeria driving herders further southwards, trees that grow in seasonally arid areas (savannah belt) and bear leaves during the dry seasons have served as source of feeds for animals. This trend, however, is not without consequences in some individuals.
Objectives: To present the clinico-epidemiological profile including the injury types and the outcome of management.
Methods: Thirty one patients with spinal cord injury resulting from fall from the Baobab or Ebony trees were studied between January 2016 and June 2018. Clinical presentations and injury characteristics – types, level of injury, associated injuries were recorded. ASIA IS grade was used to classify the cord injury. Treatment modalities were also documented. Plain radiographs, CT scan and MRI scan were used to assess the injuries. SPSS version 17 software was used to analyse the data.
Results: All 31 patients were males aged 26 to 48 years (mean of 37). Over 70% of the cases occurred during the dry seasons. Three deaths were recorded, two of which occurred while being resuscitated at the emergency room with suspected cervical spine injuries. Sixteen patients were seen within 48 hours of injury. About 75% had received unorthodox care before arriving at the hospital and most were brought in with no spine protection device. Subaxial cervical spine injury was reported in over 80% of the patients. All had neurologic involvement with over 80% presenting with complete cord injury (ASIA A). Eighteen patients were treated surgically while ten were managed non-operatively with skull traction.
Conclusions: The productive age group is mostly affected. Late presentation was common. Traditional bone setters held sway in the initial care of these patients. Most patients are increasingly being offered operative stabilization for ease of rehabilitation and early mobilization.
Keywords: Baobab/ebony trees, spinal cord injury, ASIA IS, operative stabilization.