Outcome of Spinal Cord Injury in Nigeria: A Meta-Analysis of Studies on Traumatic Spinal Cord Injury

Abstract

Kawu Ahidjo Abdulkadiri, Abubakar Kabir, Nurudeen Aminu Muhammad, Sani Abdullahi Tsoho, Mamman Muhammad Lawal and Chiroma Musa Muhammad

Background: Traumatic spinal cord injury (TSCI) is a devastating condition with significant morbidity and mortality. While individual Nigerian studies have reported varying outcomes, no comprehensive synthesis exists. This metaanalysis aimed to pool available evidence on outcomes of TSCI in Nigeria, including mortality, neurological recovery, and complication rates.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Google Scholar, and African Journals Online were searched for studies reporting outcomes of TSCI in Nigerian patients published between 2000 and 2025. Inclusion criteria: original studies reporting TSCI outcomes in Nigerian patients; sample size ≥10; published in English. Exclusion criteria: case reports, reviews, non-Nigerian studies, and studies without extractable outcome data. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled proportions were calculated using random-effects models. Heterogeneity was assessed using I² statistics. Publication bias was evaluated using funnel plots and Egger's test.

Results: Of 312 identified records, 12 studies met inclusion criteria, comprising 1,147 patients. The pooled in-hospital mortality rate was 17.6% (95% CI: 12.8–23.1%; I²=68.4%). The pooled neurological improvement rate (≥1 ASIA grade) was 28.4% (95% CI: 22.1–35.2%; I²=62.7%). Pooled complication rates were: pressure ulcers 42.6% (95% CI: 35.2–50.3%; I²=71.2%), urinary tract infections 38.4% (95% CI: 31.2–46.0%; I²=65.8%), and pneumonia 18.6% (95% CI: 13.4–24.8%; I²=54.3%). Subgroup analysis by publication year showed improvement in neurological outcomes over time (p=0.03). Egger's test revealed no significant publication bias for mortality (p=0.18) but significant bias for complication rates (p=0.04). Heterogeneity was moderate to high across most outcomes, partially explained by differences in sample size, injury severity, and study period.

Conclusion: Outcomes of TSCI in Nigeria are characterized by high mortality (17.6%), limited neurological recovery (28.4%), and substantial complications. Significant heterogeneity across studies underscores the need for standardized data collection. These findings highlight critical gaps in TSCI care and provide benchmarks for quality improvement initiatives.

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