Using a Mathematical Model to Develop an Objective Outcome Measure for Lumbar Spine Surgery in Patients with Thoracolumbar Trauma in Nigeria

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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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