Management of Spinal Injuries Secondary to Rockfall in Traditional Mines

Abstract

Introduction: Spinal injuries represent the whole of the mechanisms responsible for vertebral, disco-ligamentary and spinal cord injuries. Spinal cord in jury is life-threatening and is responsible for functional consequences that make the subsequent socio-economic integration of victims difficult. In developing countries, spinal injuries in traditional gold mining are becoming more and more frequent. Purpose: The purpose of this study was to describe the anatomopathological aspects and the results of surgical treatment of spinal injuries secondary to traditional mine collapses at the University Hospital of Kati. Patients and Methods: This was a prospective, descriptive study over 18 months, from November 2017 to May 2019. Included in this study were patients operated on for spinal trauma secondary to rockfall in traditional mines. The neurological status was assessed in each patient since admission to the department using the Fr&#228nkel score. Decompression by laminectomy combined with titanium device placement was preferred in lumbar, thoracic and thoraco-lumbar surgery . We performed an anterior cervical spine approach with SENEGAS plate placement in cervical injuries. Motor physiotherapy was associated whenever recov ery was not complete. At a minimum follow-up of 6 months, all our patients were re-evaluated by the Fr&#228nkel score. Results: The mean age was 31 years with extremes of 10 and 49 years. The majority of patients were men, 95%. Twenty patients underwent surgery. According to the spinal segments, the cervical spine was affected in 05 cases, the thoracic spine in 08 cases and the lumbar spine in 17 cases. The neurological examination revealed tetraplegia (n = 5), paraplegia (n = 12) and paraparesis (n = 3). According to th e types of lesions, we collected 12 cases of fractures, 4 cases of frac ture-luxations and 04 cases of pure luxations. According to the site, the fracture was uni-articular (n = 3), corporal (n = 15) and transverse apophyseal (n = 1). According to the type of line, the fracture was simple (n = 6), with compression (n = 11) and comminuted (n = 2). The dislocation was anterior in all 08 cases. The spinal cord injuries were concussion (n = 3), contusion (n = 6) and transection (n = 11). Sphincter disorders such as leakage or retention of urine were present in all our patients. At a minimum follow-up of 6 months, all our patients classified as Fr&#228nkel D and C had a complete motor recovery. Of the 5 patients classified as Fr&#228nkel B, 2 had complete motor recovery and one had partial recovery. Of 12 patients classified as Fr&#228nkel A, one patient had partial recovery. Conclusion: The severity of the neurological lesions in spinal injuries due to rockfalls in traditional gold mining is certain. These traumas are of high velocity and provide extensive spinal cord injuries. The dorsolumbar hinge is the most affected segment. Fractures of the first lumbar vertebra and the twelfth thoracic vertebra are the most frequent. Settling fractures are by far the most frequent fracture types. T12-L1 dislocation is the most frequent. Early osteosynthesis by spinal stabilization after reduction improves the Fr&#228nkel score. This study shows the need for public awareness of the dangers of traditional gold panning.