article · Journal of Orthopaedic Science and Research
Standard neurological scales often overlook practical, everyday recovery metrics after thoracolumbar spine trauma, including mobility, continence, and employment. To establish a practical evaluation tool for resource-limited settings, a retrospective study of 237 patients treated surgically at the National Orthopaedic Hospital Dala in Kano examined functional results over 12 months. Measured outcomes included independent grooming, walking, sitting in a wheelchair, bowel and bladder control, erectile function in males, and return to work. One year after surgery, 78.5 percent of patients could sit comfortably in a wheelchair, but only 14.3 percent walked independently and 11.0 percent returned to employment. A predictive logistic regression model incorporating baseline impairment, injury level, and age achieved strong accuracy across functional outcomes, with admission impairment grade serving as the strongest predictor of recovery.
Standard neurological assessments rarely capture the functional milestones that matter most to patients, such as independent movement, personal care, and financial independence. By translating baseline trauma assessments into clear recovery probabilities, this mathematical framework enables clinicians to establish realistic goals with patients and family members while directing limited rehabilitation resources toward the most impactful interventions.
The mathematical model could serve as a clinical decision-support tool or prognostic calculator for surgical and rehabilitation teams in resource-limited healthcare facilities. Having been applied and tested on a single-centre retrospective cohort with area under the curve metrics between 0.81 and 0.89, the methodology appears to be an applied research asset. Broader adoption would require packaging the algorithm into an accessible clinical scoring application or software tool.
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Background: Outcomes following thoracolumbar spine trauma in resource-limited settings are typically reported using neurological scales such as the ASIA Impairment Scale (AIS). However, these scales do not capture the functional outcomes that matter most to patients-mobility, self-care, employment and independence. This study aimed to develop a measurable, objective outcome system for use in resource-constrained Nigerian settings. Methods: A retrospective cohort study of 237 patients who underwent surgery for thoracolumbar trauma at the National Orthopaedic Hospital Dala, Kano (January 2019 – June 2025) was conducted. Complete SCI (AIS A) occurred in 163 patients and incomplete SCI (AIS B-D) in 74. Functional outcomes-including ability to sit in a wheelchair, maintain erection (in males), use a walker, groom independently, control urine and faeces, walk independently and gain employment-were assessed at 6- and 12-months post-surgery. A logistic regression model was developed to predict the probability of achieving each functional outcome based on admission AIS grade, injury level and age. Results: Male patients (n = 159) outnumbered females (n = 78). At 12 months, 78.5% of patients could sit comfortably in a wheelchair, 52.3% could use a walker, 38.8% achieved bowel and bladder control and only 14.3% regained independent walking. Among males, 31.4% reported ability to initiate and sustain erection. Employment return was 11.0%. The mathematical model demonstrated good predictive accuracy (AUC 0.81-0.89) for key functional outcomes. AIS grade on admission was the strongest predictor of all outcomes. Conclusions: This study provides the first objective, multi-domain outcome system for thoracolumbar trauma in Nigeria using a mathematical model. The model enables clinicians to set realistic recovery expectations and allocate rehabilitation resources efficiently in resource-constrained settings.
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DOI: 10.46889/josr.2026.7301
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