Comparing the epidemiology and associations of single- versus multi-level traumatic spinal fractures at a tertiary referral hospital in Ethiopia

Abstract

INTRODUCTION: Spinal fractures cause major morbidity and mortality globally, especially in low- and middle-income countries (LMICs); however, differences between single- and multi-level injuries remain underexplored. This study describes the epidemiology and associated factors of level-based traumatic spinal fractures in Ethiopia to inform care and policy. METHODS: A prospectively maintained registry from a tertiary referral hospital in Ethiopia (2023-2026) was retrospectively queried, stratifying spinal fracture patients into single- and multi-level cohorts. Extracted variable analyses included independent t-tests, Pearson's chi-squares, Fisher's exact tests, and multivariable logistic regression. RESULTS: A total of 223 patients were included: 85 single-level (mean age = 31.9±11.6 years; 83.5% male) and 138 multi-level (33.5±13.7 years; 81.2% male). Baseline demographics and socioeconomic characteristics were largely similar. Multi-level fractures were more frequently due to blunt trauma (23.9% versus 10.6%) and less due to road-traffic accidents (21.7% versus 34.1%; both p = 0.04). Neurological injury was more severe in the multi-level cohort, with higher American Spinal Injury Association (ASIA) A rates (49.3% versus 16.5%), and lower D (4.4% versus 20.0%) and E rates (19.6% versus 40.0%; all p < 0.001). Thirty-day mortality was higher in the multi-level cohort (27.5% versus 8.2%; p < 0.001), and admitted multi-level patients experienced longer stays (18.8±13.0 versus 13.5±10.0 days; p = 0.03). Urban residence was independently associated with lower 30-day mortality in the single-level cohort (odds ratio = 0.03; p = 0.02). CONCLUSION: Multi-level spinal fractures in Ethiopia are associated with a disproportionate burden across several clinical and epidemiological domains. These findings support the need for policy change and improved care strategies in LMIC settings. LEVEL OF EVIDENCE: Level III.