Back pain suddenly results in paralysis for Singapore teen

SINGAPORE - Woo Seik Yee had finished his Primary School Leaving Examination and he was feeling good.

One morning in October 2011, he decided to put his camera to use and went for a walk at the Botanic Gardens, where he snapped pictures of his surroundings.

When the 12-year-old got home, however, he complained of pain in his back. Then, he suddenly lost all feeling from the waist down.

His mother, Mrs Jocelyn Woo, tried to support him, but he had no strength in his legs, she recalled. Seik Yee recalled blacking out from the pain. Worried, his mother called for an ambulance.

Seik Yee was taken to the National University Hospital (NUH), where doctors diagnosed him with a disc prolapse in his thoracic spine (the portion of the spine in the upper back), a rare occurrence, especially in children.

The intervertebral disc is the cushion which separates two bone segments, or vertebrae, of the spine. When the shell of the disc tears, the gel-like material within the disc prolapses, or bulges out.

Most disc prolapses occur in the lumbar spine (the part of the spine in the lower back) and are referred to commonly as slipped discs.

They can occur due to degeneration of the disc from ageing and increased pressure on the disc that can result from sudden vigorous movements.

Lumbar disc prolapses almost never result in paralysis, said Associate Professor Joseph Thambiah, senior consultant at the division of spine surgery at NUH.

Disc prolapses in the thoracic spine would usually be caused by trauma.

Prolapses in that area or the cervical spine (neck) could affect the spinal cord and may result in paralysis, said Prof Thambiah.

This is more of a risk in the thoracic spine, where there is not much room for the spinal cord.

Prof Thambiah said: "Seik Yee came to the hospital with a thoracic disc prolapse that completely paralysed him from the waist down."

It was a medical emergency which needed immediate surgery to boost chances of any possible recovery, he added.

It was a frightening experience for Seik Yee, who is now 14, and his parents.

"I was actually not that scared until I heard that doctors wanted to operate on him," said Mrs Woo, a 44-year-old housewife.

AGE WAS ON HIS SIDE

Seik Yee had a two-stage operation.

The first stage was done that same day and lasted six hours from midnight, said Mrs Woo.

"The disc was removed and the spine stabilised with implants," said Prof Thambiah.

The second stage of the operation was done about a week later through the chest, to remove some inaccessible fragments of disc, he added.

Seik Yee could not walk even after the second operation.

"But as he was young, doctors thought his recovery could be different from an adult's. They did the second operation to help him to recover," said Mrs Woo.

Generally, the prognosis for complete spinal cord injuries such as Seik Yee's is very poor and few patients regain any useful function, said Prof Thambiah.

But Seik Yee was determined to walk again.

Five weeks after his collapse, he was discharged from NUH and started physiotherapy at Tan Tock Seng Hospital's Rehabilitation Centre in Ang Mo Kio.

It was hard work. In the first session, he tried to stand and transfer his weight from one place to another, such as from the wheelchair to the car.

He underwent robot-assisted walking therapy daily for two hours each time.

This involved walking on a treadmill, with a harness supporting his body and robotic legs supporting his legs.

"It took me about three months, but I managed to do it. I could stand up without crutches and walk with the help of elbow crutches," he said.

The total bill for surgery, hospitalisation and rehabilitation came up to $100,000, but after subsidies and insurance payouts, the family eventually paid slightly more than $3,000, using Medisave.

BACK TO SCHOOL

Seik Yee also managed to make it back to school despite missing the first term at Tanjong Katong Secondary School.

His parents had wanted him to take a year off to concentrate on his recovery.

But Seik Yee would not hear of it.

He had done well enough for his PSLE to get into the express stream and did not want to waste a year.

Mrs Woo said: "He said he made it to the four-year course, why should he take five years to do it?"

To this day, the family still does not know what caused Seik Yee's injury.

"He does not play any sports and his only outdoor exercise is swimming. He also did not have any falls," said Mrs Woo.

The couple now sends their only child to and from school every day, either by taxi with Mrs Woo accompanying him or by car if Mr Woo, a manager, is available to drive.

Seik Yee reached a milestone earlier this month, when Mrs Woo let him go to school using only crutches.

"Up till then, he was using the wheelchair as I was worried he would get tired," she said.

His next target is to walk with only one crutch while in school, something he hopes to achieve in three months.

Prof Thambiah is very pleased with Seik Yee's progress.

The spinal cord usually does not recover from injuries because it is a very sensitive neural structure, he said.

"When we operate around it, we take particular care not to touch it. Sometimes, just a small knock will cause it to stop functioning," he said.

The surgery contributed to Seik Yee's recovery, but much of it was also due to his own effort and perseverance, combined with the love of his very supportive parents, said Prof Thambiah.

He added: "It would have been easy for him to become despondent and give up hope but he showed great resilience and determination. I am very proud of him."

wanching@sph.com.sg


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