Epidemiology of traumatic spinal injuries in a low-resource setting: a retrospective cohort from southwestern Iran

Traumatic spinal injuries (TSIs) impose severe disability and healthcare burden in low-resource settings, yet comprehensive epidemiological data from southwestern Iran—specifically Khuzestan province with the nation’s highest road traffic mortality rate (32.5 per 100,000)—remain critically scarce. This retrospective cohort study characterizes the demographic profiles, etiological mechanisms, anatomical distributions, neurological outcomes, laboratory correlates, and clinical trajectories of TSI patients admitted to Ganjavian Hospital, a high-volume Level-II trauma center serving this underserved region from January 2022 to March 2024. Among 759 patients with radiologically confirmed TSIs (72.5% male; mean age 39.5 ± 12.7 years), motor vehicle collisions dominated etiology (60.1%), followed by falls (28.6%). Cervical spine was most affected (50.7%), followed by thoracic (40.6%) and lumbar (17.4%) regions. Neurological deficits occurred in 20.8% (complete motor/sensory loss 11.6%, partial deficits 7.2%). Mean length of stay was 4.3 days (range 1–46); in-hospital mortality was 2.9% (n = 22, all cardiac arrest). Cervical injuries correlated with longer stays (5.2 vs. 4.1 days thoracic, p = 0.041); injury mechanisms predicted anatomical sites (p = 0.027); initial GCS showed no mortality association (p = 0.756). However, BUN (r = 0.41) and creatinine (r = 0.38) moderately predicted hospitalization duration (p < 0.05), suggesting utility as pragmatic risk markers where advanced monitoring is unavailable.