Spine Injury(स्पाइनल इन्जुरी): Causes, Treatment & Success Rate

In this video our expert Dr. M. S Narula is talking about Spine Injury(स्पाइनल इन्जुरी) & its causes, treatment & success rate. Also he is answering some common question that people ask in OPD like:

• What are the treatment options?
• Why are we operating? 
• What is the patient recovery rate? 

Unfortunately, these injuries are very severe today because of high moving traffic and so much rush on roads with speedy vehicles. As spine surgeons, our experts often see these spine injuries or spine fractures, or polytrauma patients very commonly. These injuries are considered severe injuries not in terms of mortality but the disability and the mobility that they cause.

As our expert told you, these spine injuries are mostly seen after a roadside accident or fall from a height. These are the two most familiar modes of injuries. If someone falls from height, they land on either their spine or heels, due to which intense pressure is observed on the spine or crushing force is seen; hence there is a fracture in the spine. It can happen anywhere from the neck to the bottom. Any vertebrae can get a fracture. The second reason is that our bodies fall in different postures during accidents, resulting in fractures. There is also another injury in which the bones don’t get fractured. 

The spinal cord doesn’t get fractured; instead, the nerves press down because of jerks, more commonly called by doctors a whiplash injury. What happens in whiplash injury like if our car is standing and some other vehicle hits us from the back, then a sudden shock to the neck is felt. When doctors perform X-Ray, they don’t find any bones fractured, but the nerves are compressed.  So spine injury can be with a fracture or without fracture, and the standard two modes are fall from height and roadside accident. 

Spine injury treatment(स्पाइनल कॉर्ड इन्जुरी का इलाज): What are the treatment for spine injury? 

But before talking about the treatment, the doctors would like to sensitize you about that if you see an accident victim on the roadside where you suspect it could be a spine injury, the very important part is that we must keep the neck and the body in an immobilised state. Often you must have seen the paramedics bind the collar around the neck and keep pillows on both sides, and with the straight fixed, they shift the patients. So one must take precautions very much during shifting spine injury patients from the accident site to the hospital. We shouldn’t move their spine, there shouldn’t be any twisting sprains, or the neck should not fall back or move. 

So this is the golden period in which one can damage the spine injury if it has happened earlier. So when the patient is brought to the hospital, and the doctors think that he has a spine injury, the doctor performs an X-ray and MRI. Like our expert told you before, spine injuries can be very debilitated. Most spine injuries have their weakness like their upper Limb or legs, so either all four limbs are paralyzed, or one limb or both legs is paralyzed depending upon which part is injured. If it is in midthoracic, i.e., there is fracture or nerve pressing in the midway of the back.

Then there is fear of weakness or paralysis in both legs. And if one has a neck injury, then it’s a possibility that there can be weakness or paralysis in all four limbs. So the doctor does an X-ray and MRI of the patients; after providing a first-aid, the doctor plans its definitive treatment.

As you can see in  this model of the spinal cord the bones spinal cord bones and how nature has delicate sieve of nerves around our spine. So our nature has provided us with this structure. So these are the spinal cord bones, and if you focus on this bone cage or column, there going our nerves.

These nerves are protected inside the vertebrae column bones, so whenever there is a fracture in the spinal cord, the crushed part moves back and may press the nerve or damage it. As our expert told you before, such a sudden shock is felt that the spine doesn’t get fractured, but due to intense trauma, the nerves press down. So this is to understand that nature has provided us with the vertebrae column, which is like a cage of the spinal cord in which nerves are always protected. Unfortunately, during any injury or fracture, the broken portion presses the nerves.

Before we discuss the treatment option, Our expert would like to discuss the basic anatomy of the spinal cord. This is the model of our spine, and this is the bone of the spinal cord stacked on one other, and there is this vertebrae column in which nerves are going from neck to down. So our nature has protected the delicate structure of the spinal cord in a rigid structure of the vertebral column. During injury or in an accident, this broken portion of the bones moves back and presses the nerve. Usually, the spinal cord is protected by the bones around it, but when these bones get fractured. The crushed area moves back and presses the nerve, cutting it, or may damage it.

What are the treatment options?

Of course, when the suspected patients with spine injuries come, doctors’ first and foremost purpose is to give them pain relief because these spine injuries are very, very painful. So doctors plan their treatment after giving them painkillers and doing their X-rays and MRIs. If the fracture is stable and the vertebrae are not that much compressed , there is not much damage to weakness; the patient doesn’t have any weakness. The doctor simply recommends simple bed rest for 3-4 weeks, giving them a belt for slow mobilization.

The patients do very well in the conservation treatment. This is done only in those cases where the fracture is not that bad or not too much, which the doctor commonly calls a stable fracture, and there is no weakness in the hands or legs. And the doctor doesn’t see any compression in the MRI. But in most of these patients, there is damage to nerves. 

Either their legs are weak, or there may be weakness or numbness in their hands. In MRI, it is seen that the broken bones are giving pressure to the nerves. So in these cases, the doctor plans a surgery and advises the patients. In this surgery, this spin surgery has to be done with a very skilled spine surgeon that is why it is very specialized surgery.

The broken portion is removed from the nerve by the doctor and fixed with rods, plates, or screws. If it is a neck injury, the doctor may go from the back or front. If it is a spinal cord injury, the doctor may go back or front, the broken area is stabilized from up, and bottom, the bones pressing the nerve are removed to mobilize the patients as early as possible.

Success Rate of Spine Injury Treatment

Now, this is the most challenging question and biggest dilemma every spine surgeon faces frequently in their practices. Now, what happens when there is a spine injury and when there is minor damage to the bone? That damage is usually permanent. In a sense, the time the nerves got pressed left some damage during an accident. Yet, doctors need to operate on it, so this is the question that if it’s permanent and the nerves won’t be able to recover,  our expert have seen so many cases in which the patient is paralyzed for life.

Why is an operation needed for Spine Injury?

See, you have to understand that there is pressure on nerves, and there is no way through which a doctor can predict whether it is permanent or not. Still, it’s essential to remove the pressure so that we can give the patient the chance of recovery of nerves and the patient. And if it is an incomplete injury, there is no total paralysis then, so the chances of recovery among them are very nice. Another significant advantage of operation is that even if there is permanent damage to the nerve, the doctor can make the patient stand up, mobilize, or at least ambulatory or even on the bed, on a wheelchair after surgery.

If the doctor fixes the spine, then on the next day, the doctor can make the patient sit on their bedside and mobilize them on a wheelchair so that the patient doesn’t have a bed zoned. Otherwise, the patient is in bed for 1 to 1 half months. So the surgery definitely has its advantages provided the patients and relatives understand that the injury, recovery of nerve, recovery of leg nerve is not so much in the hand of the doctor; it is in the hands of God. Yes, the doctor can remove the pressure to give them a chance of recovery. As the doctor mentioned after the operation, they can mobilize it quickly on a wheelchair or crutches or by sitting on a bed, but this is possible only after surgery. The specialized surgery is long, but the doctor sees good results wherever indicated in expert hands.

Of course, the next question is, doctor, what happens now? Now what? 

What is the patient recovery rate? 

Like our expert  said, if it is an incomplete nerve injury, there is no complete paralysis, and there is little weakness, and the MRI report conveys significantly less damage. So, the chance of recovery is very fast, so much so that a few weeks the patient recovers, so that the recovery can take a few days to almost one year. The nerve recovery may last a long one year. So it is a lengthy recovery period in which the patient first has to mobilize. They may sit up or in a wheelchair or on crutches to improve the patient’s quality of life. So this can, and he will need a very good rehabilitation.  

After every surgery, there is a role of physiotherapy rehabilitation. Still, post-operative patients’ spine rehabilitation is of great importance in spine injury patients. So with good rehabilitation, the quality of life can be improved, and slowly, with the nerve recovery. Patients start feeling good so that the healing can last from 1 to one and half years, and the second thing is, what are its results? 

As our expert told you before, its effects are very good if done timely. If the surgery is performed timely and by expert hands and when there is not too much damage, then the results of spine injury fixation are very good. So take care. Be safe, and please drive carefully and slowly.