Traumatic and Non-traumatic Radiculomedullary Compressions: A Comparative Analysis.

Autor:	Maoneo I; Neurosurgery, University of Kisangani, Kisangani, COD., Beltchika A; Neurosurgery, University of Kinshasa, Kinshasa, COD., Ketani T; Neurosurgery, University of Kinshasa, Kinshasa, COD., Kasereka L; Neurological Surgery, Makerere University, Kampala, UGA., Akilimali P; Nutrition, University of Kinshasa, Kinshasa, COD., Ntsambi G; Neurosurgery, University of Kinshasa, Kinshasa, COD.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Oct 13; Vol. 16 (10), pp. e71352. Date of Electronic Publication: 2024 Oct 13 (Print Publication: 2024).
DOI:	10.7759/cureus.71352
Abstrakt:	Background Radiculomedullary lesions represent a significant public health issue, with their epidemiological, clinical, and therapeutic characteristics varying depending on whether they are of traumatic or non-traumatic origin. The aim of this study was to compare clinical, therapeutic, and postoperative aspects between traumatic radiculomedullary lesions (TRML) and non-traumatic radiculomedullary lesions (NTRML). Methods This was a prospective cohort study conducted from 2020 to 2023 involving patients suffering from radiculomedullary lesions operated at the Department of Neurosurgery, University Teaching Hospital of Kinshasa. In addition to socio-demographic characteristics, the two patient groups - traumatic and non-traumatic - were compared based on clinical, therapeutic, and postoperative aspects using the American Spinal Injury Association (ASIA) and Spinal Cord Independence Measures (SCIM III) scores.  Results We included 153 patients, with 73 traumatic cases (47.7%) and 80 non-traumatic cases (52.3%). TRMLs were predominantly caused by road traffic accidents (34%) and falls (11%), while NTRMLs were mainly due to disc herniations (22.2%) and tuberculosis (13.7%). The mean age for TRMLs was 35.4 ±12.8 years with a sex ratio of 3.5, compared to 50.7±15.9 years and a sex ratio of 1.1 for NTRMLs. TRMLs were more frequently located in the cervical region (32.8%) and the thoracolumbar junction (40%), whereas NTRMLs predominantly affected the thoracic (22.5%) and lumbar (63.7%) regions. Patients with NTRMLs had more incomplete lesions (98.7%) and better SCIM III scores at admission compared to TRMLs (p ˂ 0.001). TRMLs had more complete deficits 42 (57.3%) vs 1 (1.3%). Both groups significantly improved their ASIA and SCIM III scores postoperatively (p ˂ 0.001) but in a similar manner (Diff-in-diff: ASIA, p=0.955; SCIM, p=0.967). TRMLs developed more complications than NTRMLs (p˂0,001). Only five patients (11.6%) with ASIA A progressed to higher grades, and all remained dependent (SCIM III score ˂50). The average hospital stay was 89.2 ±74.2 days for TRMLs and 57.5±52.9 days for NTRMLs (p˂0.001). Conclusion This study revealed that TRMLs frequently affect young male individuals and are often located in the cervical region and thoracolumbar junction. In contrast, NTRMLs affect older individuals without gender preference and are usually found in the thoracic and lumbar regions. TRMLs often lead to complete deficits, pressure sores, urinary infections, and longer hospital stays compared to NTRMLs. Both patient groups showed significant postoperative improvement with no significant difference between them. However, patients with complete deficits showed less improvement in both groups. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the School of Public Health (University of Kinshasa). issued approval No. ESP/CE/046/2023. The protocol of this study was validated by the local Ethics Committee of the University of Kinshasa. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Maoneo et al.)
Databáze:	MEDLINE
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