Using the Outcome of Subaxial Cervical Spine Trauma with Complete Spinal Cord Injury to Develop a Scoring System to Determine Surgical Intervention at National Orthopaedic Hospital Dala, Kano, Nigeria

Background. Complete cervical spinal cord injury (ASIA A) carries a grave prognosis with minimal neurological recovery. Surgical intervention remains controversial where presentation delays are common. This study analysed outcomes of complete cervical spine injury and developed a practical scoring system to guide surgical decision making at the NOHD, Kano, Nigeria.

Methods. A retrospective cohort study of 167 patients with traumatic complete cervical SCI (ASIA A) managed at NOHD between January 2018 and December 2024 was conducted. Data extracted included demographics, injury mechanism, time to presentation, MRI parameters (intramedullary lesion length, IMLL), haemodynamic management (mean arterial pressure, MAP), surgical timing, and 12 month neurological outcome. Multivariate logistic regression identified independent predictors of improvement. Significant predictors were weighted by regression coefficients to create a scoring system, validated by bootstrap resampling.

Results. Of 167 patients, 124 (74.3%) were male; mean age 42.8 ± 15.6 years. Only 22 (13.2%) patients showed any neurological improvement at 12 months, all of whom had incomplete baseline injuries. Independent predictors of favourable outcome were: time to surgery ≤7 days (OR 4.5; p < 0.001), admission MAP ≥85 mmHg maintained for first 72 h (OR 3.8; p=0.002), and IMLL ≤15 mm on MRI (OR 3.2; p=0.005). A 9 point scoring system was developed: surgery ≤7 days (4 points), MAP ≥85 mmHg (3 points), IMLL ≤15 mm (2 points). A score ≥6 predicted any neurological improvement with sensitivity 72% and specificity 86% (AUC 0.83).

Conclusion. Complete cervical SCI patients rarely recover, but a small subset with favourable predictors may benefit from surgery. The proposed scoring system emphasises modifiable factors-early decompression and haemodynamic optimisation – to guide resource allocation and patient counselling.

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