Spectrum of Clinical Presentation of Cervical Spinal Cord Injury in Ado-Ekiti

Abstract

Background: Cervical spinal cord injury (CSCI) is a devastating condition associated with significant morbidity and mortality, particularly in low- and middle-income settings where pre-hospital care and trauma systems are often suboptimal. Understanding the clinical spectrum and determinants of outcome is essential for improving management strategies.

Objective: To evaluate the spectrum of clinical presentation and identify predictors of mortality among adult patients with cervical spinal cord injury in Ado-Ekiti.

Methods: This was a hospital-based prospective descriptive and analytical study conducted over an 18-month period between July 2024 and December 2025 and involved 43 adult patients with confirmed cervical spinal cord injury. Data were collected using a structured proforma for capturing socio-demographic characteristics, injury mechanisms, clinical presentation, radiological findings, management, complications, and outcomes. Neurological status was assessed using the ASIA impairment scale. Data were analyzed using descriptive statistics and multivariate logistic regression to identify predictors of mortality, with statistical significance set at p < 0.05.

Results: The majority of patients were males (72.1%), with the peak age group being 18–30 years (27.9%). Road traffic accidents were the leading cause of injury (65.1%), with motorcycle-related incidents predominating. Most patients presented late, with over half presenting after 24 hours, and 67.4% received no pre-hospital care. Clinically, neck pain (81.4%), limb weakness, and severe neurological deficits such as quadriparesis (46.5%) and quadriplegia (41.9%) were common. Complete spinal cord injury (ASIA A) was observed in 32.5% of patients. The mortality rate was 18.6%, while only 23.2% achieved functional independence at discharge. Independent predictors of mortality included complete injury (aOR = 6.85, p = 0.006), upper cervical level involvement (aOR = 4.92, p = 0.019), respiratory difficulty (aOR = 5.63, p = 0.014), and delayed presentation beyond 24 hours (aOR = 3.76, p = 0.048).

Conclusion: Cervical spinal cord injury in Ado-Ekiti predominantly affects young males and is largely due to preventable causes such as road traffic accidents. The clinical presentation is often severe, with a high burden of neurological deficits and complications. Mortality is significantly associated with injury severity, higher cervical involvement, delayed presentation, and respiratory compromise. Strengthening pre-hospital care, promoting early presentation, and improving acute management may enhance outcomes.

Keywords:

Cervical spinal cord injury, clinical presentation, mortality predictors, Nigeria.

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