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SPINAL FRACTURES – HOLISTIC CARE BY SPINAL NEUROSURGEON

Spine fracture can result from high-velocity injury and low-velocity injury. High-velocity injury include
Road traffic accident
Fall from height
Industrial accidents
Sports injuries

These injuries are often serious and require intensive and emergency treatment. Low-velocity injury like slip and fall can cause spine fracture in people with pre-existing conditions that weakens the bone. In elderly people, osteoporosis is the common cause of spine fracture, whereas tumour/cancer invading the spine and spine infections can lead to spine fracture in younger people with low-impact injury. In severe osteoporosis, spine can get fractured even without a minor trauma. Fracture can involve the thoracic, lumbar or cervical spine.

How can a spine injury present?

Our spine not only supports our body but also protects the delicate spinal cord by encasing it in the bony spinal canal. So, the spinal cord can also be damaged in spine fractures. The severity of the injury depends on the level of fracture (i.e.) neck, upper back or lower back, involvement of spinal cord and nerves, and velocity of injury.

Fracture of the spine causes severe neck or back pain incapacitating the individual. In case of minor fractures, walking may be pain-free but change of position like getting up from bed or chair, or turning around in bed trigger a catchy pain. If the spinal cord or nerves are damaged, the person can develop weakness of arms and legs or legs alone, numbness in the limbs and disturbance in passing urine or stools.

When to approach a doctor?

Even a minor fracture in spine should be dealt cautiously as inadequate management may lead to deformity (hunch-back) or nerve damage. Your doctor will examine you to assess the muscle power and sensation in your limbs and evaluate your urine/toilet disturbances. He/she may take an X-ray, CT scan and/or MRI scan to find the extent of spinal bone and nerve damage. In case of pathological fracture (i.e.) fracture due to preexisting disease, more investigations need to be done to find or confirm the disease.

Management:

Treatment depends on the fracture pattern, instability from the injury and associated neurological injury. Treatment methods include

Conservative management with rest and spine braces
Open surgery to stabilize the bone and relieve  the nerves from pressure
Minimally invasive key-hole surgery
Complex surgery- anterior reconstruction
Conservative management

Minor fractures with stable pattern and normal nerve functions can be managed with bed rest and restricted ambulation with specialized spine braces. In osteoporotic fractures, tablets, nasal sprays or injections to improve the bone strength, and calcium and vitamin D supplements will also be administered. The duration of rest and type of spinal brace is best decided by your treating doctor.

Minimally invasive surgery

The objectives mentioned above can also be achieved with key-hole surgery. Advantages of this technique include lesser blood loss during surgery, less pain, earlier recovery and smaller scars. The choice of open or key-hole surgery depends on many factors and can be discussed with your doctor.

Open surgery
The main objectives of the surgery are
Reduce the fractured bone to proper position
Stabilize the fracture
Relieve the spinal cord or nerve from the pressure
so that the chance of nerve recovery is increased.

During the surgery, the spine bones are stabilized with specialized screws and rods or plates and the alignment of the bones are brought back to normal.

If there is nerve injury, decompression procedure to free up the space available for the nerves and relieve the pressure will also be bone. If pre-existing disease is suspected, tissue will be obtained from the diseased site for testing (Biopsy).

Complex surgery

In severe injuries with significant bone damage and resultant deformity, complex procedures like anterior reconstruction by surgery through the neck, chest or abdomen may have to be done.

WHAT IS SPINAL CORD INJURY?

A spinal cord injury can occur either from an injury or from a disease to the vertebral column or spinal cord itself. In most spinal cord injuries, the backbone pinches the spinal cord. The spinal cord may become bruised or swollen. The injury may actually tear the spinal cord and/or its nerve fibers.

With a spinal cord injury your spinal cord can be injured in any place from neck to the lower back. Just like an electric cable stops sending current beyond the point it is damaged, messages from the brain stop passing beyond the injured part. The area below the injured part of the spinal cord becomes paralyzed with variable loss of sensation and movements. Depending upon the level of injury you could be either a paraplegic (loss of movements in the legs with normal hand functions) or quadriplegic (loss of function in both the legs and hands).

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What is complete or incomplete injury?

The complete injury is like cutting off all electric service to a building. No messages can be sent from the brain to the parts of the body below where it is cut. Sometimes the spinal cord may not be completely severed, but may be damaged so severely, that the injury is still complete. An incomplete injury is like stopping electric supply to some offices in a building, but not all of them.

Some messages can get through, while others cannot. The amount and type of messages that can pass between the brain and parts of the body will depend on how many nerves are damaged. These have significant prognostic implication.

All Your Doubts About Rehabilitation Answered

Does the patient need rehabilitation after Spinal Cord Injury?

Spinal Cord Injury (SCI) can cause severe physical disability to the person. The treatment and rehabilitation focuses on intensively working with patients physically and psychologically, so that in a short period of time they can maximize their neurological recovery and general health. We educate SCI patients about all aspects of their injury and long term care. We want patients to return home as independent and productive as possible, prepared to resume their lives.

How Can Rehabilitation Help?

Persons with spinal cord injury will have permanent disability and with rehabilitation they can develop new skills, or train themselves or their family to optimise their independence and quality of life. It is very important to select a system of care that provides specialized treatment, care, services, team and equipment because of the complexity of these injuries.

We provide a comprehensive, specialised, multi-disciplinary rehabilitation service that equips patients with the skills, knowledge and information for them to return to their role in society with the highest feasible level of functioning, independence and opportunity. Only a centre like HAMSA REHAB will provide such a holistic care.

What is done at the Rehabilitation centre?

Our spinal rehabilitation pathway is a consultant led service encompassing input from a range of therapy professionals, including physiotherapy, occupational therapy and specialist nurses. Along with the physical elements of rehabilitation, there is an emphasis on psychological and social rehabilitation. A majority of patients with a spinal cord injury have been through a traumatic event and often require intensive psychological support to help them overcome this.

Team who will be involved in the care:
Doctor
Physiotherapist
Occupational therapist
Nurse
Psychologist
Orthotics specialist
Social worker
Vocational trainer

What is the treatment offered?

A team, with specialist expertise in spinal cord injury rehabilitation co-ordinate the care of the patient and evaluate their progress and adapt goals accordingly. We provide an on-going assessment of a patient’s progress in their abilities and level of independence in daily activities (i.e. dressing, walking etc). Individuals must be medically stable and able to participate in, and benefit from an intensive rehabilitation programme as their condition allows.

Treatment involves
Wheel Chair training
Gait training
Transfers
ADL – Activity of Daily living
Bladder management
Bowel management
Skin care
Balance and mobility
Psychological therapy
Community inclusion

In Association With

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    Spinal cord problems in elderly people and the treatments
  • Spinal cord injuries and treatments | Doctor Naanga Eppadi Irukanum| News7 Tamil
    Spinal Cord Injury Rehabilitation and treatment, Interview with Dr G Balamurali, Sun TV
    Spinal Cord Injury Treatment, Interview by Dr G Balamurali in Newsglitz
Dr.G.Balamurali
Dr. G. Balamurali is one of the leading spine surgeons in Chennai. He is internationally trained in all niche aspects of Spine Surgery. He has over 24 years of surgical experience in this field.
Kauvery Hospital,
No.199 ,LUZ Church Road,
Mylapore,Chennai– 600004
Tamilnadu, India
Kauvery Hospital Front Area

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