Clinical Profile, Injury Pattern, and Management Outcome of Patients with Traumatic Spinal Injury at a Tertiary Care Centre in Nepal

Abstract

Background: Traumatic spinal injury (TSI) is an important cause of morbidity and disability, with its epidemiological characteristics and management patterns varying according to geographic, socioeconomic, and healthcare factors. Data from Nepal, particularly from western Nepal, remain limited. This study aimed to describe the clinical profile, injury patterns, neurological status, management, and in-hospital outcomes of patients with traumatic spinal injuries treated at a tertiary care center in Pokhara, Nepal.

Methods: A descriptive, cross-sectional, hospital-based study was conducted at Nepal Manipal Teaching Hospital, Pokhara. Medical records of patients admitted with traumatic spinal injuries over a two-year period from 1 April 2024 to 31 March 2026 were reviewed. Patients of all ages and sexes with complete medical records were included, while patients with non-traumatic spinal pathology, incomplete records, or incomplete diagnostic evaluation were excluded. Demographic characteristics, mechanism of injury, time from injury to hospital presentation, anatomical level, fracture morphology, neurological status according to the American Spinal Injury Association Impairment Scale (AIS), treatment modality, hospital stay, complications, and in-hospital mortality were analyzed.

Results: A total of 61 patients were analyzed. The mean age was 50.5 ± 18.9 years (range, 17–86 years), and 39 (63.9%) were male. Falls were the predominant mechanism of injury, accounting for 47 cases (77.0%).The mean interval between injury and hospital presentation was 10.1 ± 11.6 hours, with 59 patients (96.7%) presenting within 24 hours. Lumbar injuries were most common (28, 45.9%), followed by thoracic injuries (15, 24.6%), multilevel injuries (9, 14.7%), and cervical injuries (9, 14.7%). Compression fractures were the predominant morphology (39, 63.9%), followed by burst fractures (16, 26.2%). Forty-seven patients (77.0%) were neurologically intact (AIS E), while 14 (23.0%) had neurological impairment (AIS A–D). Forty patients (65.6%) were managed conservatively and 21 (34.4%) underwent surgery.. Hospital stay was significantly longer in the surgical group than in the conservative group (median 13 vs. 4 days; P<0.001). One surgical-site infection was documented, and no in-hospital deaths occurred.

Conclusion: Traumatic spinal injuries in this tertiary-care cohort from Pokhara predominantly affected males and were mainly associated with falls, particularly falls from height and trees. Lumbar and compression injuries were most common, and most patients were neurologically intact and managed conservatively. The predominance of fall-related injuries highlights the need for locally relevant injury-prevention strategies, public awareness, and appropriate early transfer and management of patients with spinal trauma.