Injury-presenting time varies from one patient to another [24].  Our overall injury-presenting time is 64.7 +- 62.7 hours. This is a far cry from what obtains in advanced countries with respect to victims of traumatic injuries. In an ideal and optimally functioning trauma system it is considered acceptable for only 10% of patients to arrive after 360 minutes(6hours) of injury [25]. In our study however, only 12(7.9%) presented within the 360 minutes. This is a far cry from ideal as majority of our patients presented between 24 hours and 96 hours (74.4%). Those who presented within 24-48 hour accounted for 61(40.1%) while those between  49-96 hours accounted for 30.3% of cases. Only 19 (12.6%) patients presented within 24 hours out of which 12(7.9%) arrived in the golden hours of 6(360 minutes). This clearly signify gross delay in arrival of patients that needed critical care within a short period.

There was no statistically significant difference in injury-presenting time among ASIA score categorization (Table F). However, patient with ASIA B had the highest mean injury-presenting time of 101.1 hours. Perhaps the preservation of sensory function propelled this group not to present early. But

ASIA E presented early 42.7 hour (male) and 24 hours(female) among all of them which shows that patients with paraparaesis are more eager to recover. ASIA A with 60.7 hours while the rest of the ASIA A, C, D, and have mean injury-presenting time ranging from 42.7 to 54.0 hours. This delayed presentation can be explained by the level of preparedness of the relations, believe pattern and possibly distance from the hospital or the means of transportation.

The influence of mechanism of injury on the injury-presenting time is noted with object falling on individual presenting early while mining associated injuries present late. This is not unexpected because most of these group of patients (miners) are not physically, emotionally and financially prepared for the sudden disability and hence the delay. These are itinerant work force in practice and often considered” casual” in their practice of mining with no formal training nor resources to cater for uncertainty.

It is important to note that despite the severity of the ailment some of the delay is from patronage of traditional healers and prayer homes prior to presentation [26]. These alternative cares are apparently popular as a result of historical and cultural practices that are often cheaper. This conception still persist despite acknowledgement of the fact that orthodox intervention is the better option and of necessity.            

In spite of the lateness in presentation a significant number of these patients still could not afford the definitive treatment meant for them. Among our patients 20(13.2%) discharged themselves against medical and surgical advice despite persuasion from the attending physicians and the social welfare department and were never seen again. This often occur among persons of low socioeconomic status, male gender and younger age often on drugs [27]. In addition, this tendency to abscond are almost always due to poor finances and the weakness in the health care financing system that cannot intervene further without directly outsourcing financial support from sympathizers or relations [26,27].

Patients with spinal cord injuries are at high risk of mortality and 48% mortality was reported in India within week and 52% after a week of sustaining injury [28,30]. There is correlation between mortality and spinal level of injury and spine injury-presentation time as all the diseased patients sustained mid-cervical injuries. High mortality is reported among complete injuries and pulmonary complications are most commonly implicated. Higher mortality in lumbar spine injury was however reported in Southern Iran [29]. These patients also sustained associated injuries to the chest and abdomen. This pattern of injuries is common among the miners.

Pressure sores remain a great source of concern in spine injured patients because apart from pulmonary and urinary systems it constitutes a great source of sepsis to a spine patient. Among the others that got healed at early stage 4(2.6%) became recalcitrant to treatment protocol and became a source of great debility. This is often complicated by osteomyelitis, joint destruction, muscle necrosis, soft tissue erosions and recurrence [31,32]. This lesion is very difficult and expensive to manage.

Consequent over these futures is the rising number of spines injured patients in our center over the period is due to the availability of spine services becoming visible and available to the community. This is exhibited by the modest increase in number of spine injured (figure 2) presenting for treatment compared to the number that were treated between 1984 to 1997 in the same center and in other centers such as in Maiduguri Ilorin and in Maiduguri, Nigeria [33,34].

The gross gender disparity as depicted by the ratio clearly demonstrates that spine injuries, although a sub-set of trauma, is a disease of the male not only in Nigeria, but also in Iceland (Europe) [35]. Women emerged prominently only in inadvertent situations such as road traffic crash, falls, falling object and building collapse. Whereas male gender, are involve in deliberate events in search of means of livelihood. This is evident by increasing deliberate involvement in mining which although dangerous still attracts enormous patronage among the young adult male. Despite this, the injury presenting-time among women is shorter than that of men despite the fact that they are less financially endowed. Factors such as family support and the role of responsible spouse suffices here.

Road traffic crash has remain the major and established cause of spinal cord injuries in developing countries and in developed countries [32-35]. While in developed countries not using seat belt is the main cause of injuries in those climes, in Nigeria, other causes suffice. The intervention of Federal Road Safety corps has reduced the presentation time of accidentally injured patients on the highway. In spite of this, the injury-presenting time has remained high 58.2 hours (Table C). The distance from site of crash may be responsible but the input of the bread winner or the person responsible for the bills in decision making might have prolong this period.

The emerging trend with respect to mechanism of injuries is the prominence of mining associated injuries which is becoming more visible [26]. The city of Jos made its global prominence as a result of its historic commercial mining fields of tin and columbite over the past century. Commercial mechanize mining started in 1904 and became a prominent export commodity for the country [36,37]. The absence of regulated, mechanize and protected mining protocols gave room to sudden rise of itinerant artisans who are relentlessly becoming victims of fallen land mass and often buried alive [37]. The occupational hazards exposed to these miners exceeds the tolerable and acceptable limits which are often not clearly defined. While in Malaysia issue of work place hazards among miners are those of ergonomics and disabilities which usually occur after retirement but in our setting, it’s a matter of life threatening and incapacitating spine injuries and even death [38].

There are many causes of spine injuries spine injuries yet trauma does not discriminate among all ages. It is known to be common among young male individuals [39,40]. The age difference is grossly skewed to the detriment of the young. Patients below 40 years alone, responsible for 56.3% of all the victims of spine injuries in our study. What may be responsible is the abundant amount of energy and the quest to succeed and the instinctive pursuit to thrive in the mist of harsh economic reality unemployment among the youths. In underdeveloped and poor countries pedestrians, passengers in buses and trucks drivers and cyclists suffer higher burden of morbidity and mortality due to increase exposure to hazardous but legitimate activities [41]. The mean age of these male patients is 38.3 years while that of female is 44.6 years. Almost all of the victims of mining mishaps are young adults and usually from low socioeconomic class too. This portents’ an unimaginably dangerous, disproportionate burden of incapacitation on the families and society as a whole. They form the bulk 20(13.2%) of those who sign against further intervention due lack of funds for investigation and treatment.