The cervical spine is a complex anatomical structure that plays an important role in balancing the skull and protecting the cervical spinal cord. Its involvement is common in accidents and falls [1] . Cervical spine injuries account for 20% of spinal traumas and are found in 70% of polytrauma cases [2] [3] . The aim of this study was to review the epidemiological, clinical, and therapeutic aspects of cervical spine trauma in our context.

We conducted a retrospective descriptive study in the neurosurgery department of the Conakry University Hospital, covering the period from October 2019 to October 2023. The study focused on the medical records of patients hospitalized for cervical spine trauma during the study period. Data collection was done using a pre-established data collection form, where we gathered parameters such as age, sex, medical history, clinical data, paraclinical data, and management details.

During the study period, we recorded 173 cases of spinal trauma, 121 of which involved the cervical spine, representing 69.23%. The mean age of the patients was 32.8 years ± 15.6. A male predominance was noted, with a sex ratio (M/F) of 2.45.

The lesions were mainly located in the lower cervical spine, with a predominance of dislocations (62.80%).

65 (53.71%) of our patients underwent surgery within an average of 11.26 days. We recorded 47 patients who were discharged against medical advice and 9 deaths before surgery.

64 (98.46%) patients were operated on with an anterior approach, using plate and screw osteosynthesis and bone graft placement, while one patient (1.53%) underwent occipito-axial wiring with steel wires. The outcome was stable in 53 (81.53%) patients and favorable in 12 (18.46%). We recorded 1 (1.53%) case of delayed wound healing, 49 (72.05%) cases of decubitus complications, and unfortunately, 26/49 cases of death, resulting in a mortality rate of 53.06%.

Out of a total of 173 cases of spinal trauma recorded during our study period, we identified 121 cases of cervical spine trauma. Cervical spine trauma represented 64.28% of spinal trauma cases in Congo, according to Ekouele M. et al. [4] . Our results align with literature data and could be explained by the high mobility of the cervical spine compared to other spinal regions [5] - [7] . In our study, young adults were the most commonly affected (51.23% were aged between 26 - 40 years), with a strong male predominance (71.07% and a sex-ratio of 2.45), and an average age of 31.92 years ( Table 1 ). Our findings are consistent with those reported by Kpelao et al. [8] , Motah et al. [9] , and Bemora J.S. [10] , who reported average ages of 37.04 ± 19 and 36.1 years, respectively, with a male predominance of 69.78% (sex-ratio 2.3). This age group, which represents the active population, is therefore more exposed to various forms of accidents and incidents. Thus, traffic accidents (47.10%), landslides (27.27%), falls (6.61%), and work accidents (2.47%) were the main circumstances of occurrence found in our series ( Table 2 ).

The absence of Level III centers in secondary cities, the delay in patient admission (81.81% of patients admitted more than 6 hours after the trauma) ( Table 3 ), and the conditions under which patients were transported (92.56% were transported without medical assistance) are factors that exacerbate initial injuries and influence the clinical condition of patients at admission. Bemora J.S. et al. [10] reported that 36.69% of their patients were transported without medical assistance and 31.65% were admitted within 6 hours of the trauma. Indeed, 52.06% and 34.71% of our patients were classified as A and B, respectively, on the ASIA scale ( Figure 1 ). In a series covering all vertebro-medullary traumas, Motah et al. [9] reported 58.1% of cases as grade A on the ASIA scale. These results underscore the severity of cervical spine trauma, with the violence of the injuries illustrated by imaging ( Graph 1-4 ).

The lesions found in our series mainly affected the lower cervical spine with 62.80% ( Table 4 ) of cases involving dislocations. This was consistent with the series by Goldberg W. et al. [11] , who reported involvement of the lower cervical spine in 39.3% of their patients, with frequent involvement at the C6-C7 level.

A total of 65/121 patients were operated on, the majority after more than 72 hours of hospitalization ( Figure 2 ). 64 patients underwent osteosynthesis with bone graft via an anterior approach, while one patient had occipito-axial wiring with steel wires via a posterior approach. Our results could be explained by the financial constraints faced by our patients, in the absence of a state insurance policy that would allow the population to anticipate the management of such unexpected events. This significant factor greatly compromises prognosis and inevitably exposes patients to decubitus complications, which require additional resources for difficult management. In the literature, Loembe et al. [12] reported an average surgical delay of 10 - 14 days, while Kpelao et al. [8] reported a 83.8% surgical intervention rate. Although the anterior approach was the most commonly performed surgical technique in our series, posterior and circumferential approaches are also used depending on the case [13] . However, these are rarely performed in our context due to the lack of perioperative neuro-navigation, which would allow for a safe and more precise surgical procedure.

The outcomes were favorable in 18.46%, stable in 81.53%, and complicated by delayed wound healing in 1.53% and decubitus complications in 72.05%, with 26/49 cases of death, representing a mortality rate of 53.06%. The progression of patients after surgery depends on the severity of the lesions, the timing of the care, and the technique used. It is also compromised by the frequency of decubitus complications, which are very common both in developed and developing countries [14] and are one of the leading causes of intra- and post-hospital death. The mortality rate is reported to be 5.6% in developed countries and varies between 7% and 35% in developing countries [4] [15] [16] .