TITLE:
Complete Spinal Cord Injury (ASIA A at Admission) after Traumatic Spinal Injury at Bouaké University Hospital (Côte d’Ivoire): Associated Admission Characteristics and In-Hospital Outcomes
AUTHORS:
Koffi Yves Soress Dongo, Yao Bernard Fionko, Faozo Stephane Landry Teti, Kouadio Jean-Baptiste Keke, Koffi Jean Jacques Kouassi, Keableon Louis Aymar Derou, Aderehime Haidara
KEYWORDS:
Traumatic Spinal Cord Injury, Complete Spinal Cord Injury, ASIA Grade, AOSpine Classification, Functional Recovery, Côte d’Ivoire
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.16 No.4,
October
28,
2026
ABSTRACT: Objective: To describe the burden of complete spinal cord injuries (grade A of the American Spinal Injury Association Impairment Scale, ASIA, at admission), the admission characteristics independently associated with them and their in-hospital vital and functional outcomes, among patients admitted for traumatic spinal injury to an Ivorian referral centre. Methods: Analysis of a single-centre cohort (2017-2021 retrospective; 2025-June 2026 prospective) of 366 patients admitted for traumatic spinal injury (383 records screened, 17 excluded), reported according to STROBE. The main exposure was complete injury (ASIA A at admission) versus non-complete injury (ASIA B - E, including 43 patients without neurological deficit); a sensitivity analysis restricted the comparator to ASIA B - D. Hierarchised outcomes were in-hospital mortality (primary), complications, and neurological and walking recovery among survivors. Bivariate comparisons and multivariable logistic regression were performed. Results: Complete injury was present in 147 patients (40.2%). These patients more often had spinal shock (29.9% vs 10.0%) and a type C bony lesion per the AOSpine classification (51.0% vs 38.4%), with thoracic involvement as frequent as cervical involvement. The admission characteristics independently associated with completeness were spinal shock (adjusted OR: 3.46; 95% CI: 1.90 - 6.31) and type C bony lesion (adjusted OR: 1.66; 95% CI: 1.06 - 2.61), whereas non-medicalised transport was inversely associated (adjusted OR: 0.55; 95% CI: 0.34 - 0.88). In-hospital mortality was 35.4% in ASIA A patients versus 5.5% in ASIA B - E patients (adjusted OR: 10.5; 95% CI: 5.2 - 21.0; AUC: 0.79), and 5.1% in ASIA B - D patients (crude OR: 10.2; 95% CI: 4.8 - 21.5). Respiratory complications were more frequent (32.0% vs 13.7%). Among survivors, no ASIA A patient regained functional walking (0% vs 57.0%) and recovery of at least one ASIA grade was lower (31.6% vs 53.9%). Conclusion: Complete injuries represent a major burden in this West African cohort, associated with excess mortality, high respiratory morbidity and very limited functional recovery. Early ASIA assessment, prevention of secondary complications and organisation of rehabilitation appear to be concrete and accessible priorities.