CHENNAI: When Justin Jesudas, a paralympic swimmer, met with an accident a few years ago, he was not severely hurt. He recalls, “I was able to sit up and make the call. The ambulance came, I was taken in and the paramedics asked me where I had pain. I told them it was in my neck and they moved it...that’s when it happened.” His C6 bone (in his spinal cord) was affected and he became a quadriplegic.
Spinal cord injuries (SCI) can occur in any of the four sections of your back bone. In comparison to the West, where spinal cord injuries occur in the elderly, in India it is mostly among youngsters. “High risk groups are the 20s and 30s. Most injuries are due to fall from heights, especially trees or construction sites, road accidents and from carrying a heavy load on the back,” says Dr Karthik Kailash, consultant orthopaedic and spine surgeon, Sri Ramachandra Medical College. The other causes are sports, gun shot wounds and even tumours.
Injuries
SCI can cause complete paralysis of the body, and can even paralyse the internal organs. “When an injury of this kind occurs, there is firstly a loss of blood supply to the spinal cord, because of which the patient cannot feel anything or move,” explains Dr Karthik.
The extent of the injury depends on the accident and its impact. The injury till L1 region causes loss of movement and motor senses, and the patient becomes either paraplegic (can move upper body but not lower body) or quadriplegic (loss of mobility in all four limbs). If the injury is in the lumbar region, more often than not, the person can walks using crutches. Injuries in the cervical region can also lead to quick death.
The injuries may or may not have affected the brain. That’s why a neurosurgeon checks the patient. “There are two types of injuries: complete and incomplete. When the neurons are intact and only the tracts are affected, it can be reversible. It is just a temporary impairment. We declare it complete injury when there is loss of blood supply,” explains Dr KV Karthikeyan, senior consultant neurosurgeon, Chettinad Hospital. Any patient with a spinal cord injury loses bladder and bowel control as their motor senses are affected.
Where they happen
Though most SCIs occur due to an accident and a fall, the injury leads to paralysis when the spine fractures while transporting the patient or if the patient is moved in the wrong way. “As a thumb rule, all accident victims should be laid still. All their injuries must be treated as SCI,” says Dr Karthik.
He warns against lifting their head up and offering water. “During 80% of the high velocity accidents, there is injury to the spine. Sometimes they seem fine and the paramedics are unaware. So when they move the neck of the patient, their actions can worsen the situation,” he rues.
Paramedics are taught to first immobilise an accident victim using a cervical collar and a spinal board. “If every injury is treated the same way, then use of the spinal board and cervical collar becomes a necessity. That awareness is lacking now. Transporting a patient from the accident spot to the hospital in the correct way is crucial as once the patient is in the hospital, the doctors will take all necessary precautions,” he adds. “The patient needs to be moved like a log and jerks should be avoided at all costs.”
B Prabhudoss, head, marketing and communication, GVK EMRI, that runs the 108 ambulance claims that the paramedics are aware of all the protocol. “Usually, we know that a person has injured his spinal cord when they complain of back or neck pain and we immediately use the collar and spinal board. Our paramedics are trained in assessment too. But, in our country we seldom get time for assessment at the scene. We rush the patient into the ambulance and take them to the hospital,” he says.
Treatment
When the patient is in the hospital, all the three tests — MRI, CT Scan and X-Ray — are taken. “Only an MRI can show the extent of the injury. By then, we check for the movement in legs and hands as well as other senses. We also rule out brain injuries,” says Dr Karthikeyan. The patient is then taken through certain surgeries and it takes about four-six weeks to conclude if they are paraplegic, quadriplegic, or in shock. Depending on that, further treatment and rehab is prescribed.
The spinal cord in a nutshell
Spinal cord in an extension of the brain that is present inside the spinal column that supports the weight and helps conduct movements. It consists of 21 pairs of nerves that helps in movement of the upper and lower limbs, chest and abdomen. The cord is divided into four sections: Cervical, Thoracic , Lumbar and Sacral.. The cervical division (C1-C8) regulates breathing, head and neck movement, heart rate, wrist and elbow movement, hand and finger movements. The Thoracic division (T1-T12) takes care of the stability of the body and regulates temperature. The Lumbar division (L1-L5) gives hip and knee movement and the Sacral division (S1-S5) is responsible for bowl and bladder, and sexual activities.
SCI facts
● Deep vein thrombosis, urinary tract infections, muscle spasms, osteoporosis, pressure ulcers, chronic pain, and respiratory complications
● In India till 1966, there were no dedicated facilities for spinal injury patients. The first programme for SCI patient was started at CMC Vellore hospital by
Dr Mary Varghese
● According to a report, International perspectives on spinal cord injuries by WHO in 2013, 5 lakh people suffer SCI every year. Males are most at risk between the ages of 20-29 years and 70 years and older, while females between the ages of 15-19 years and 60 years and older. Studies report male to female ratios of at least 2:1 among adults. Around 90% of the injuries are traumatic.
What do the numbers in tamil nadu say?
A study by a group of doctors under
Dr N Sridharan in 2015 at the Rajiv Gandhi Government General Hospital Chennai, titled Epidemiologic evidence of spinal cord injury in Tamil Nadu, India, showed that:
Most common age group for SCIs in both males and females was 20 to 40
While C5 and C6 were the highly affected areas in males, L1 was most commonly affected in females