Case 1: Cervical trauma
Lukman Bashir, a young man sustained a broken neck following a road accident. The bones in his neck had shifted and this caused pressure on his spinal cord. He was paralysed at the time. But following an operation, there was improvement in his condition and on review three months later, he had recovered to be normal.
In truth, the operation was performed within six hours of his sustaining the injury and this may have contributed to his remarkable recovery. But, it may also be that the spinal cord was not permanently damaged so relieving the pressure quickly helped to salvage the situation.
Other patients may not be so lucky
In some situations, the spinal cord could have been damaged completely at the time of the accident. In such situations, the possibility of recovery depends on “miracle.” This then brings up a very difficult scenario for the patient. We as doctors have to give hope and manage the psychological trauma of what is a massive change in the life of the patient. Sadly, sometimes that lingering hope leads to exploitation by fake pastors and some doctors peddling cure. This can lead to huge expenses and further disappointment to the patient.
When things like prayers and stem cell therapy do not work for you, there is no way of getting your money back. The pastor will say you did not have faith and the doctors in India, Germany, or even nowadays, in faraway China, will say you waited too long before coming.
Helpers do harm
Some patients may break their spines without damaging the spinal cord, but helpers (rescue workers at the scene of the accident) then contrive to damage their spinal cord by overzealousness. Aggressively pulling people out of vehicles at scenes of an accident sometimes cause massive injuries. Instead, there is the need to call and allow specially trained workers, including the fire brigade, police and emergency rescue teams to manage such rescue operations. This avoids calamities in many situations.
Case 2: Cervical Myelopathy
The other condition worthy of note is the degenerative disease of the spine causing pressure on the spinal cord. This is the same cervical spondylosis or arthritis in the neck which we have discussed before. In many patients, it causes neck pains, arm pains and perhaps difficulty in writing. Usually, it affects a single nerve but if it is affecting the spinal cord, it can lead to paralysis and severe disability. In many such situations, the patient has weakness of the hands and legs, numbness of the hands and feet, poor control of urine and difficulty in walking. It can be so bad that walking is impossible, and passing urine and faeces becomes uncontrollable.
Many patients with the severe form end up unable to move and to perform social functions, such as holding a mobile phone, eating or cleaning themselves. Some have to be carried about like babies. This is severe cervical myelopathy but it is preventable. It can be prevented by early diagnosis and immediate intervention with surgery. Surgery remains the mainstay for managing moderate and severe cervical myelopathy in many parts of the world.
Cervical myelopathy is a common cause of spinal dysfunction in the elderly. Since arthritis is a condition of old age, cervical spondylosis and cervical myelopathy is common in older people. But those older people are between the ages of 70 and 80 in many other countries except Nigeria. In Nigeria, the condition is commonly seen in patients in their 50s.
So, it appears to occur in the younger age group in Nigeria where it is frequently not diagnosed early. Many patients ignore the symptoms until there is significant muscle wasting and disability. Some, of course, have been to facilities where the disease is not diagnosed or effective treatment offered. We have seen situations where specialists proffer diagnosis and treatments beyond their level of expertise.
Diagnosis and treatment
Neurosurgeons and spine specialists are trained to recognise, diagnose and treat spine diseases like cervical spondylosis. In this respect, the treatment for moderate or severe cervical myelopathy is surgical. Surgery removes the new bone formed (hard like concrete) from pressing on the nerves and spinal cord. This then allows information from the brain to pass through to the muscles. So, the muscles wake up to their responsibilities and the work of movement.
Orthopaedic surgeons and neurologists are specialists involved in managing cases of cervical spondylosis and cervical myelopathy. Physiotherapists are also very important in the management of spine diseases but everyone needs training and collaboration. The training allows them to recognise when conservative treatment modalities are effective and when surgical treatment is required. The collaboration ensures that multidisciplinary teams work locally to give optimum treatment of real benefit. It also allows research and audit of outcomes to stimulate quality of care.
Surgery for spine diseases
The operations can be performed effectively and safely in Nigeria. We have formed the special purpose vehicle to promote such in Abuja: Spine Fixed in Abuja. So, now you know.
NB: The Annual General Meeting and International Scientific Conference of the Association of General and Private Medical Practitioners of Nigeria ended on Saturday. The whole shindig was eventful and memorable for many reasons.
I will write about the highlights and key health points for you next week.