Long-Term Functional Outcomes Following Spinal Surgery for Traumatic Spinal Cord Injury in Nigeria: A National Prospective Registry Study

Traumatic spinal cord injury (TSCI) causes devastating long-term functional disability, and the outcomes of surgical decompression and stabilization in Nigerian patients are entirely uncharacterized in prospective registry data. This dissertation establishes and analyzes the first national prospective registry of TSCI surgical outcomes in Nigeria. A national registry was established at six spine surgery centers representing all geopolitical zones, prospectively enrolling 280 patients with TSCI who underwent surgical intervention between 2019 and 2023. Neurological function was assessed preoperatively and at 3, 6, 12, and 24 months using the ASIA Impairment Scale (AIS). Functional independence was measured using the Functional Independence Measure (FIM). Secondary outcomes included surgical complications, pressure sore prevalence, urinary infection rates, and healthcare cost. AIS grade improvement of one or more levels was achieved in 41% of patients at 24 months, predominantly those classified AIS C or D preoperatively. Functional independence scores improved significantly in cervical and thoracolumbar injuries when surgery occurred within 24 hours (p=0.001). Delayed surgery beyond 72 hours was the most common modifiable adverse factor. Pressure sore incidence was 53% at 12 months, reflecting inadequate community rehabilitation infrastructure. The registry represents a major original contribution to TSCI research in Africa. Recommendations include national spinal cord injury rehabilitation centers, early surgical decompression pathways, and community nursing support programs. Keywords: spinal cord injury, TSCI, functional outcomes, spinal surgery, Nigeria registry