KUTRRH has yet again given a shot of life to a patient. The 40-year-old patient who was a victim of a hit and run accident suffered a neck fracture that left him paralyzed on both the lower and upper limbs. The patient was attended to at a local hospital which referred him to KUTRRH for advanced treatment An MRI (Magnetic Resonance Image) revealed that the patient had a severe dislocation of the spine in the neck with bony materials squeezing the spinal cord. That caused the paralysis of the upper and lower limbs. He underwent anterior cervical discectomy and a fusion surgery that involved a two-step procedure.
1. Anterior Cervical Discectomy
The surgery is conducted through the anterior or the front of the cervical spine (neck). The disc is then removed from between two vertebral bones. This surgery has several advantages:
• Direct access to the disc.
The anterior approach allows direct visualization of the cervical discs, which are usually involved in causing stenosis, spinal cord or nerve compression. Removal of the discs results in direct nerve and spinal cord decompression. The anterior approach can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck
down to the cervicothoracic junction,called the C7-T1 level, which is where the cervical spine joins with the upper spine (thoracic spine)
• Less postoperative pain.
Spine surgeons often prefer this approach because it provides access to the spine through a relatively uncomplicated pathway. The patient tends to have less incisional pain from this approach than from a posterior operation.
This surgery is done at the same time as the discectomy operation to stabilize the cervical segment. A fusion involves placing bone graft and or implants where the disc originally was,
to provide stability and strength to the area.The surgery was a success, and the patient was discharged after intensive physiotherapy at KUTRRH’s rehabilitative department. Jackson is
now able to resume his day-to-day operations. He is very grateful for the services provided at KUTRRH at a very affordable cost. Research shows that spinal trauma, comprising fractures to the spinal column and spinal cord injury represent a significant challenge for patients, clinicians, and healthcare systems worldwide. While the annual incidence of traumatic
spinal injuries is approximately 45-80 cases per million worldwide, low- and middle-income (LMICs) countries experience up to 130 cases per million. Reports confirm that rates of spinal trauma are 1.6 times higher in LMICs than high-income countries. The sensorimotor and autonomic nervous system dysfunction following spinal trauma results in life-long disability and long-term healthcare challenges.
In Sub-Saharan Africa, acute mortality from spinal trauma ranges from 18% to 25%, compared to near zero in developed nations. Spinal trauma leads to considerable financial strain for
patients, families, and society at large due to direct medical costs and lost wages. This high socioeconomic burden is further heightened in the LMICs, where some nations spend over
$2 billion annually, including $5 million per case of paraplegia and $9.5 million per case of quadriplegia. Without adequate rehabilitation services in most LMICs, patients rely heavily on
family members for care.Cervical spine trauma (CST) represents the most severe form of spinal trauma with increased rates of morbidity and mortality compared to thoracic and lumbar injuries.
Damage to the cervical spinal cord results in all the same sequelae as thoracic and lumbar Spinal Cervical Injury (SCI) along with upper extremity weakness and respiratory impairment due to diaphragm and upper intercostal muscle dysfunction. Over 40% of CST patients present initially with complete SCI, while the remaining present with an incomplete injury (40%) or no cord injury (20%). CST occurs in 2% to 10% of all polytrauma patients. CST presents additional challenges given the added expertise and risk involved in surgical intervention. Various studies have reported the scarcity of trained surgeons, adept surgical teams, and surgical resources in LMICs. Neurosurgery is tertiary and expensive, leaving operative resources scarce throughout less-resourced countries.Many LMIC regions report low rates of operative treatment for CST due to lack of equipment and implants.Given the devastating effects of CST in less-resourced environments, an epidemiologic investigation is needed to better understand this patient population. In a population of CST patients from a major East Africa referral center,
the objectives were to:
• Describe the presentation and operative treatment patterns.
• Report predictors of neurologic improvement
• Assess predictors of mortality
06 JUly 2023 KUTRRH THE CHECKUP VOL. 4 ISS