The earliest responsibility for the management of a spinal cord injured patient immediately after an accident usually falls to a person trained in first aid or occasionally to a doctor. Patient who has suffered a major accident should be fully examined for spinal injury. Movements of the spine can be dangerous – it may further damage the cord. Hence field health staff must ensure transportation of these patients on wooden plank or on a stretcher ‘in one piece’ as shown in fig.1. This must be followed strictly during transportation until spinal injury has been ruled out by emergency staff by careful examination and suitable tests i.e. X-Rays, CT Scan or MRI. Unconscious patients should be treated as if they had spinal cord injury until and unless proved otherwise. Early Management of spinal cord injured patient includes administration of first aid by trained staff, careful positioning of patient in bed and judicious use of drugs. It has been shown that administration of steroids in high dosages with in 8 hours of injury has significant improvement in weakness. Once patient’s general condition is stable plan for definitive stabilization of spine can be made. This can be achieved by various modalities either by postural methods or by surgery. Today with better understanding of biomechanics of spine, better instruments and excellent anaesthesia, surgery has become very safe. It is generally agreed that one goal of surgery in addition to decompression of spinal cord is patients can be mobilized out of bed early thus leading to reduction in complications of recumbency and facilitation of nursing care. Whereas surgical stabilization of spine is one aspect of treatment success of treatment depends on total rehabilitation of the patient (enabling him live life independently). This is best achieved in comprehensive spinal cord injury centers where attention is paid to complete care of spinal cord injured.
These centers are meant to provide specialized treatment to spinal cord injured patients. In the specialized spinal unit treatment is aimed at preventing life threatening complications. Most effective method of spinal stabilization for early mobilization is coordinated with specialized nursing, occupational therapy, physical therapy and medical psychological readjustment. Efforts are made to encourage paraplegics, participate in various national and International sporting events. This type of approach enables the patient to cope with his or her disability. Counseling sexual rehabilitation is of utmost importance to these patients, most of whom are young and healthy. Group discussions of common difficulties encountered in adjustment to a new way of life help the patient and family to cope. Vocational rehabilitation begins before discharge from the hospital. The patient is advised about occupations that can be performed from the wheel chairs. The functional rehabilitation in specialized centers ensures these patients a much greater life expectancy than was possible several years ago. With the increase of violent accidents in our mechanized society and the constantly improving medical care, the size of this patient group will continue to increase. At the present time they require expert medical care. In the future, it is hoped that techniques will evolve for prevention and reversal of spinal cord paralysis. New research in the horizon may enable us to prevent the catastrophic permanent functional loss of limbs due to Post traumatic paralysis. Newer surgical techniques will provide immediate rigid stability of the injured spine thus providing better environment for recovery from incomplete cord injury, mobilizing the patient early, and then rehabilitation to provide maximum functional independence.
Dr Raj Bahadur is Professor and Head, Dept. of Orthopaedics, Govt. Medical College and Hospital, Chandigarh.
Dr Mohinder Kaushal , Ex Registrar Dept. Of Orthopaedics, Govt. Medical College & Hospital, Chandigarh