CERVICAL SPINAL CORD INJURY FROM A VEHICULAR ACCIDENTAL NEAR HANGING INJURY AND NECK MANIPULATIONS

J.A. Balogun1,2, T.A. Malomo1, and O.A. Badejo1,2

  1. Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria.
  2. Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract

Spinal cord injury is a global problem. It is a devastating life altering condition that is associated with permanent disability and reduced life expectancy. Road traffic accident has been described in global literature as the commonest aetiology and second to it is falls. Identifying these factors have led to development of policies and advocacy to reduce these causes of spinal cord injuries.
We present three cases of spinal cord injuries from unusual aetiologies viz-aviz an accidental hanging which resulted in a C4 traumatic myelopathy Frankel A in a 30-year old artisan, playful neck manipulation in a 23-year old male student, resulting in Brown-Sequard syndrome, which resolved with nonoperative spinal cord injury management protocol over six weeks and a C4 traumatic myelopathy Frankel D with a 50% anterior listhesis of C4 on C5 in a 50-year old man who sustained injuries from a choke hold 10 weeks prior to presentation. He recovered fully on non-operative management and discharged home Frankel E.

Keywords: Spinal cord injury, Browne-Sequard, Frankel

Correspondence:

Dr. J.A. Balogun
Department of Neurological Surgery,
University College Hospital,
Ibadan, Nigeria.
Email: jamesabalogun@gmail.com

Introduction

Spinal cord injury (SCI) is a devastating life altering condition, which may be associated with permanent disability and can also lead to decreased life expectancy. It has long been recognized as a key problem in West Africa1.

Several aetiological factors for SCI have been described in the literature. Globally, the most common aetiology for spinal cord injury remains Road traffic accident (R.T.A.), followed by falls2. The 2007 global estimates reports an incidence of 133-226 thousand incident cases from R.T.A. and violence3. This tallies with the findings of the studies that have reported different aetiological factors for spinal cord injury in Nigeria. A 4- year review by Solagberu B.A. with 39 patients, showed R.T.A. as the cause of injury in 67% of the patients, falls in 23%, while misadventure accounted for injuries in 10% of the study group4. This study however did not explain what is classified as misadventure. A larger series spanning a 10-year period between 1997- 2007, with 161 patients also showed 79.7% injuries due to R.T.A., 13.4% of cases due to falls and 10% of cases were due to assault and 1% not clearly defined.

Though falls and road traffic accidents constitute the main mechanisms for spinal cord injuries, other less prominent mechanisms of spinal cord injuries resulting mainly in incomplete spinal cord injuries also form a group that are of concern. When hanging usually nonjudicial, does not result in fatality, it is described as near hanging. Neurologic injuries with a predominance of head injuries, from near hanging have been described mostly amongst prison inmates attempting suicide5. There is an estimated 1348/100,000 population near hanging injuries in the United States population annually6.

The identification of these aetiologies, has provoked an effort towards reduction of road crashes in particular through legislations and advocacy as well as bringing to fore the near hanging injuries which may not be considered when developing laws and protocols for spinal cord injuries.

We present three (3) cases of cervical spinal cord injuries from unusual mechanisms of inadvertent and forceful neck manipulations and an accidental near hanging.