What drives clinic follow-up after traumatic spinal injury? An observational cohort study from Tanzania

In a Retrospective Observational Cohort Study Ikwuegbuenyi et al. From Muhimbili Orthopaedic Institute, Dar es Salaam; Weill Cornell Medicine, New York publisher in the journal BMJ Open to identify demographic, injury-related, and healthcare system factors associated with clinic follow-up adherence after traumatic spinal injury (TSI) in Tanzania. Fewer than 13% of patients remained in follow-up at 12 months post-TSI. Key predictors of clinic return included private insurance, injury mechanism, shorter hospital stay, neurological improvement, and female sex. The authors call for targeted strategies to enhance long-term follow-up in LMICs ⁷⁾.

The study attempts to quantify and elucidate predictors of follow-up adherence among patients with traumatic spinal injuries in a low-resource setting. While the topic is relevant, particularly given global disparities in neurosurgical care, the analysis remains superficial. The selection of variables lacks depth—omitting psychological, transportation, or caregiver support factors. The authors rely heavily on retrospective registry data, yet provide minimal discussion of data quality or loss to follow-up bias beyond basic exclusions.

There is also insufficient interrogation of systemic barriers endemic to Tanzanian healthcare—such as infrastructure deficits or cultural mistrust of allopathic medicine—that could more meaningfully contextualize the findings. The regression analysis is underutilized; while odds ratios are presented, there’s no effort to model interaction effects or assess multicollinearity. Additionally, the use of ASIA Impairment Scale categories in logistic regression, without discussion of baseline functional capacity or socioeconomic stratification, undermines interpretability.

The tone is utilitarian and dry, bordering on inert. The paper reads like a minimally annotated statistical report rather than a critical exploration. Structurally, the abstract frontloads methods but compresses conclusions, failing to reflect the significance of key results. The body of the manuscript (not shown) likely suffers from similar flattening, based on this presentation.

For practicing neurosurgeons—especially those in LMICs—the clinical utility is limited. It’s unclear how this data informs discharge planning, triage, or targeted intervention. There’s no discussion of actionable mechanisms to improve follow-up, such as mobile health (mHealth) platforms or community health worker models. Additionally, the demographic skew (86% male) is acknowledged but unexplored, missing an opportunity to question why women have better follow-up despite being a minority of the cohort.

This study raises a crucial problem—poor longitudinal care after spinal trauma—but fails to deliver an insightful or impactful analysis. It identifies correlates, not causes, and provides no meaningful roadmap forward. The absence of a more layered discussion renders it of limited value beyond bureaucratic benchmarking.

• Takeaway for Neurosurgeons: Insurance status and neurologic improvement predict clinic adherence after spinal trauma, but structural solutions remain absent.
• Bottom Line: A shallow statistical treatment of a deep healthcare inequity; lacks the critical insight or practical relevance needed by frontline neurosurgeons.
• Rating: 4/10

• Article Title: What drives clinic follow-up after traumatic spinal injury? An observational cohort study from Tanzania
• Citation: Ikwuegbuenyi CA, et al. BMJ Open. 2025 Jun 25;15(6):e101267. doi:10.1136/bmjopen-2025-101267.
• Corresponding Author Email: scott.zuckerman@vumc.org