Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo

Background: Significant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. Methods: This is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post -operative complications and outcome. Results: We admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 +/- 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 +/- 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short -segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p -value : 0.838 and 0.468 respectively). Conclusion: Our establishment faces many challenges in TSCI surgery: lack of pre -hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.