War-Related Traumatic Spinal Cord Injuries During the Syrian Armed Conflict in Damascus 2014–2017

Introduction: The Syrian civil war has been ongoing for over a decade, resulting in the erosion of the health and wellbeing of the Syrian population. Urban combat zones have led to significant civilian injury. The literature is sparse regarding central nervous system injuries sustained by civilians during war. This study aims to characterize traumatic spinal cord injuries (SCIs) in civilians during the Syrian war.

Methods: A retrospective cohort study was performed on surviving patients with war-related SCIs admitted to Damascus hospital between December 2014 and November 2017. Data on demographics, injury characteristics, imaging findings, interventions, and neurologic status was collected. Chi-squared and binary logistic regression were used for analysis.

Results: Among 68 patients, 52 (76.5%) were male with an average age of 26.2. Most injuries (88.2%) were isolated to the spine, with cervical injuries having the highest mortality rate (61%; p = 0.004). The most common type of SCI was due to metal fragments (n=40, 58.8%) and that was associated with gunshot injuries (p=0.015). The thoracic spine was the most common injury site (n=33, 48.5%) and was associated with neurologic deficits upon discharge (p=0.006). Most patients (70.6%) were managed conservatively with a low incidence of herniation (1.5%). Foreign body removal was the most common indication for surgery (60%), and 84.2% of surgical patients had neurological deficits at discharge, with paralysis (57.4%) and numbness (32.4%) being the most common. Surgery was associated with higher survival during admission (OR = 0.768 [0.629-0.937]; p=0.050).

Conclusion : This study highlights the severe impact of the Syrian civil war on civilian traumatic SCIs. Cervical injuries showed a high mortality rate and thoracic injuries frequently led to neurologic deficits. Our data suggest that neurosurgeons in Damascus were highly selective in approaching cases operatively possible due to a lack of resources. However, our findings suggest higher survival for patients who underwent surgery. Further research is essential to better address the long-term consequences of traumatic SCIs in such settings.