CHANGING PROFILES IN SPINAL-CORD INJURIES AND RISK-FACTORS INFLUENCING RECOVERY AFTER PENETRATING INJURIES

Objective: The changing profiles of spinal cord injuries in South Afri ca are addressed in this study. Design: A retrospective analysis of 55 1 patients with spinal cord injury. Materials and Methods: The cause o f injury was motor vehicle crashes in 30%, stab wounds in 26%, gunshot wounds in 35%, and miscellaneous causes 9%. Measurements and Main Res ults: There was a significant shift from stab wounds towards bullet wo unds over the last five years. Bullet spinal cord injuries increased f rom 30 cases in 1988 to 55 cases in 1992, while stab spinal cord injur ies decreased from 39 cases in 1988 to 20 cases in 1992. The incidence of spinal cord injuries following a motor vehicle crash showed a decl ining tendency after a transient increase (28 cases in 1988, 40 in 199 0, 31 in 1992). Moreover, the problem of severe septic complications h as been investigated and various risk factors for sepsis that might im pair the rehabilitation process have been examined. The risk of develo ping septic complications was higher in gunshot spine injuries (21 cas es out of 193) than in knife injuries (5 cases out of 143). The presen ce of a retained bullet did not seem to increase the chances for sepsi s. In seven patients the sepsis was the direct consequence of the reta ined bullet while in 14 patients sepsis developed with no bullet in si tu. Furthermore, the site of the injury (cervical, thoracic, lumbar sp ine) did not correlate with the above mentioned risks. Conclusions: Gu nshots carry a heavier prognosis, Only 32% of our gunshot cases underw ent a significant recovery as opposed to 61% of stab cases and 44% of the motor vehicle crash victims.