TITLE:
Management of Spinal Injuries Secondary to Rockfall in Traditional Mines
AUTHORS:
Coulibaly Kalifa, Traoré Youssouf, Tambassi Sory Ibrahim, Sanogo Cheick Oumar, Diallo Aboubacar, Traoré Soumana, Traoré Issa, Djerma Issa
KEYWORDS:
Trauma, Spine, Traditional Gold Mining, Mali
JOURNAL NAME:
Surgical Science,
Vol.14 No.2,
February
20,
2023
ABSTRACT: Introduction: Spinal injuries represent the whole of
the mechanisms responsible for vertebral, disco-ligamentary and spinal cord
injuries. Spinal cord injury 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 Fränkel 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 recovery was not
complete. At a minimum follow-up of 6 months, all our patients were
re-evaluated by the Fränkel 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 the types of lesions, we collected 12 cases of
fractures, 4 cases of fracture-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 Fränkel D and C had a complete motor
recovery. Of the 5 patients classified as Fränkel B, 2 had complete
motor recovery and one had partial recovery. Of 12 patients classified as Fränkel
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 Fränkel score. This study shows the
need for public awareness of the dangers of traditional gold panning.