Consequences of neglected traumatic spinal cord injuries

Abstract

Objectives: Spinal cord injuries cause major disabilities and are devastating events for both patients and healthcare providers. Most traumatic spinal cord injuries (TSCIs) are due to motor vehicle accidents (MVAs). Neglected injuries result in complications and poor outcomes. Here, we investigated the causes, consequences, and outcomes of neglected TSCIs. Methods: This case series study was performed at King Abdulaziz Medical City, Riyadh, KSA. Of the 750 patients treated between February 2016 and February 2021, 18 patients met our inclusion criterion of neglected highenergy TSCI with neurological deficit, necessitating surgical intervention more than 14 days after the index trauma. Results: Of the 18 patients with neglected TSCIs, 72.2% were men. The patients’ mean age at the time of injury was 36.8 years, 77.8% were from outside Riyadh, and all patients had MVA-induced TSCIs, 88.9% of which were attributable to delayed referral to a tertiary center. The mean duration of neglect was 43 days, and the longest duration was 125 days. The most common site of injury was the thoracolumbar region (55.5%). The American Spinal Injury Association impairment scale score improved in two patients. Bed sores occurred in 55.5%, and deep vein thrombosis occurred in 27.8% of patients. Postoperatively, 77% of patients required intensive care unit admission. Most patients (12) did not receive specialized spinal cord injury rehabilitation postoperatively. Conclusion: Early referral of patients with TSCIs is crucial to prevent short- and long-term complications.