SINGAPORE - Recent news of a local university student being paralysed after sustaining a spine fracture highlights the devastating consequences which can occur from such injuries.
Depending on the severity of the spinal cord injury, patients often do not make full recovery despite intensive rehabilitation.
In addition, patients who sustain spine trauma very often belong to the younger age group, whose members are in the most productive period of their lives.
They are involved in sports and activities which certainly put them at greater risk for spine trauma.
The cost of treatment can also be substantial.
Neurological deficits such as paralysis, while not life-threatening, have long-term effects and place huge burdens on the patient, family and society at large.
However, the advances in spine surgery have improved the odds for such patients.
BETTER CHANCE OF RECOVERY
Take the cases of Mr ZJ and Madam SS.
Mr ZJ was lifting a heavy load when he fell backwards.
The fall was awkward and he heard a loud crack coming from his back.
An excruciating pain followed and he passed out.
By the time he woke up, he was already in hospital and immobilised, to prevent further injury to his spine.
A scan of his back revealed a fracture of one vertebral body in his lumbar spine.
After undergoing urgent surgery to stabilise his fractured spine, he was discharged from hospital five days later.
Madam SS, a tourist from Asia, was enthusiastically taking photographs in Sentosa when she slipped and rolled down a flight of stairs.
She was in terrible pain but, thankfully, she was still able to move her limbs.
An ambulance took her to the emergency department and a scan showed that her spine was fractured at two levels.
She also underwent urgent spine surgery and was discharged after five days.
Both she and Mr ZJ walked out of the hospital without any help.
Mr JB suffered much more serious injuries.
He was working at a height when the platform he was standing on suddenly gave way.
He fell through it and landed on his buttocks.
He was not able to move his legs and was sent to the emergency department.
A magnetic resonance imaging scan of the spine showed a severely compressed fracture and a bone fragment impinging on the nerves supplying his lower limb.
At the same time, he had acute retention of urine.
He lost the sensation that his bladder was full and he just could not pass out urine even though he strained as hard as he could.
Like Mr ZJ and Madam SS, he also had urgent spine surgery using minimally invasive techniques.
He was transferred to a rehabilitation centre a week after his surgery.
Three months later, at his outpatient clinic review, he walked into the clinic with the assistance of a walking stick.
MINIMALLY INVASIVE SURGERY
In most instances of spine trauma, treatment involves surgery to stabilise the spine so that complications can be prevented to give the patient the best chance for rehabilitation.
In this respect, there is some good news.
Spine surgery for trauma has evolved from traditional open surgery to present-day minimally invasive surgery.
These techniques minimise the incisions needed for surgeons to access the problem area.
The treatment is tailored to each patient, and not all patients are suited for such spine surgery.
However, in cases where this type of surgery is possible, the aim of the minimally invasive surgery is to achieve the same outcomes as traditional open surgery, while causing less disruption to surrounding tissues.
The result is often faster healing, a shorter hospital stay and definitely less post-operative pain.
Outwardly, the surgical wounds are smaller and the resultant scars are not as large and unsightly as those caused by traditional surgery.
This has come about due to innovations which enable the insertion of implants through small incisions.
Screws and rods are inserted in a minimally invasive manner through small incisions in the skin under X-ray guidance, with minimal tissue disruptions.
To aid in the accuracy of implant placements, navigation systems are also becoming more common.
In future, the material used to manufacture the implants may be stronger. This could result in smaller implants and, as a result, even smaller incisions.
Dr David Choy is a neurosurgeon at Raffles Hospital. He has a keen interest in the use of advanced techniques of minimally invasive spine surgery in the treatment of spine tumours, as well as degenerative and trauma-related spine problems. He also provides paediatric neurosurgical services and manages complex conditions of the brain located in the base of the skull bone.
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