Injuries occurring in the neck, will lead to weakness of the upper and lower limbs, while, injuries occurring in the back will result into weakness of the legs.
--By Dr Gaurav Raj Dhakal
In a day, at least one patient suffers from spine injury. In Nepal, the majority of the injuries are due to road traffic accidents and falls. The location of the injury dictates the functional outcome of the patient. Whether there is paralysis of all the four limbs or only the legs depends on the region of the trauma in the spine.
Injuries occurring in the neck, will lead to weakness of the upper and lower limbs, while, injuries occurring in the back will result into weakness of the legs. After the injury has occurred, rehabilitation of the patient begins. Initially the patient is placed on a spine board, to prevent movement occurring in the unstable spine and a collar is placed around the neck, to protect the cervical spine. The spine injury can be managed either surgically or conservatively depending upon the nature of the trauma.
An air mattress is placed for the paraplegic (loss of power in the lower limbs) and quadriplegic patients (loss of power in the upper limbs). The air mattress prevents the occurrence of bed sores. Anti-embolic compression stocking are put over the lower limbs to prevent the occurrence of clots in the veins of the legs. Because these patients lose their ability to pass urine by themselves, a catheter is placed to drain the urine. Paraplegic patients are then trained to drain their urine by use of an external catheter intermittently and the indwelling catheter is removed. Indwelling catheters are a potent source of infection if placed for a prolonged time.
Intensive chest physiotherapy and movements of limbs are carried out under the supervision of a physiotherapist. Patients with spine injuries are prone to chest infections, urinary infections, bed sores, osteoporosis, deep vein thrombosis and depression. Frequent counseling sessions and psychiatric consultations are necessary to motivate them and avoid depressions.
Once the acute stage has passed, patients are then provided wheel chairs, encouraged to mobilize with mobility aids. They are then enrolled into vocational training programs and counseled on the type of work they can take up, keeping into consideration their functional ability. Home visits are conducted and household amenities are modified and made more accessible and friendly.
Today, with the rehabilitation and vocational programs, most of the patients with spine injuries have made a comfortable transition into the society and have taken up jobs that suit their ability the best. In Nepal, there exists a world class rehabilitation center for spine injured patients at Sanga, Kavre wherein, all the equipment, facilities and manpower exists to cater to these patients. The Spinal Injury and Rehabilitation Center recently was instrumental in managing the earthquake victims suffering from spine trauma.
Unlike in the West, we do not have any spine injury support groups. Support Groups are essential to create awareness in the society and educate school children on spine trauma prevention and road safety, providing first aid, advise the government on formulating policies, provide rehabilitation and vocational aid to patients. Our architects, engineers and builders should also focus on making public places and transport wheelchair accessible!
Dr Gaurav Raj Dhakal is a consultant spine surgeon at Norvic International Hospital, Om Hospital and Nepal Police Hospital. He has completed a clinical spine fellowship at Park Clinic, Kolkata, India and a Pediatric Spine Fellowship at Riley Children Hospital, Indianapolis, USA. He was also involved in the AO Spine Research Commission Programme.