Injury mechanisms and severity of traumatic spinal cord injury: road-traffic crashes determine lesion frequency rather than prognosis. a cohort study of 366 patients in Côte d’Ivoire

Background: Injury mechanism is often regarded as a marker of severity in traumatic spinal cord injury (TSCI). We assessed whether it is an independent determinant of neurological severity, polytrauma and in-hospital mortality. Methods: Single-centre observational cohort of 366 patients with confirmed TSCI (2017–2021 and 2025–2026) at the Bouaké University Hospital Center, reported according to STROBE. Mechanisms were compared with chi-square and rank tests; the independent association with mortality was estimated with adjusted Firth penalised regression, with internal validation by bootstrap. Results: Median age was 35 years and 80.9% were men. Road-traffic crashes predominated (62.6%); complete injury (ASIA A) affected 40.2% of patients and in-hospital mortality was 17.5%. Age differed by mechanism (p < 0.001), but mechanism was associated with neither neurological severity, nor lesion level, nor polytrauma, nor recovery (all p ≥ 0.13). After adjustment, road-traffic crashes were not associated with mortality (OR 0.92; 95% CI 0.46–1.84). The only independent determinants of death were ASIA grade A (OR 11.21; 95% CI 5.54–22.67) and cervical involvement (OR 2.08). Conclusion: Mechanism accounted for the epidemiological distribution of TSCI without independent prognostic value; initial neurological severity remained the main factor associated with death. Prevention should target road-traffic crashes, and clinical orientation should rely on neurological assessment.