lecture given in IMA

1. CAUSES,MANAGEMENT
AND REHABILITATION
Prof.G.S.Patnaik
Professor orthopedics
IMS and SUM Hospital

4. “By symptoms of numbness
and palsy of arms and the
urine and excrement
coming against their will
and knowledge, you may
fore tell that death is at
hand for reason that spinal
marrow is hurt”
Ambroise Pare
(1510 – 1590)

6. “Condition not to
be treated”
Edwin Smith’s papyrus
(circa 1550 B.C.)

7. “Concept of
spinal cord
injury center
as a separate
unit”
Sir Ludwing
Guttman
(1943) Stoke
Mandevelle, U.K.

9. Spinal unit
acts as
spinal cord
injury
center for
Oman

10. Spine Injury
Etiology
USA Oman
Falls 25%
Sports 2%
Violence 5%
Others 3%
MVA 65%
Falls 20%
Sports 15%
Violence 15%
Others 5%
MVA 45%

11. Spine Injury
• Scaffold safety

12. Spine Injury

13. Driving is probably your
most dangerous activity
• Driving in Oman is some
5-10 times more
dangerous than driving in
Europe

14. Spine Injury

15. Spine Injury

16. Spine Injury

17. Spine Injury
Incidence
USA : 11 000 New cases per Year treated
4 800 die at the accident site
2 40 000 Prevalence
30 – 40 per million per year with
Neurology
Male to Female ratio 4:1
Oman :225 patients per year
10 – 25 % with Neurological
deficit
Male to Female ratio 3:1

18. Spine Injury
Surgical Anatomy

19. Spine Injury
Surgical Anatomy

20. Spine Injury
Surgical Anatomy
SCIWORA

21. Spine Injury
Spine injury should be
suspected in all cases of
polytrauma, facial injuries,
Unconscious and intoxicated
patients
A- Airway
B- Breathing
C- Circulation & CERVICAL
SPINE
“Eye cannot see, What mind
doesn’t think “

22. Spine Injury

23. Spine Injury
Physical Examination

24. Spine Injury
Physical Examination

25. Spine Injury

26. Spine Injury
“Adversity is great,
but man is greater
than adversity”
Tagore

27. Spine Injury
Stability
Dennis concept
• Mechanical Stability
• Neurological Stability
“Treatment failure is
often due to rigid
adherence to
definitions without
individualizing
treatment for each
patient”
Dorr et al
Spine 7(6) 1982

29. Spine Injury
Fracture Atlas

30. Spine Injury
Fracture Odontoid Fracture Axis

31. Spine Injury
Fractures C3 to C7

32. Spine
Injury
• Denis’ Classification of Fracture Dislocation

33. Spine Injury
Denis’ Classification of Flexion Distraction Injuries

35. Spine Injury
Denis’ Classification Burst Fractures

36. Spine Injury
• Denis’
Classification
of
Compression
fracture

37. Spine Injury
Management
• Medical Decompression? ?
• ‘A Randomized controlled trial of
Methylprednisolone or Naloxone in the
treatment of acute spinal cord injury’
Bracken et al (N.Engl. J. Med.
333: 1405:1411,1990)

38. Spine Injury
• Non Operative Management
Gardner-Wells

39. Spine Injury
Halo

40. Spine Injury
Orthosis

41. Spine Injury
• Operative Management
Goal
Preserve
Protect
Promote
Methods
Reduction
Fixation
Decompression

42. Approach ?
– Posterior
– Anterior
– Posterior + Anterior
– Anterior + Posterior
– Anterior + Posterior +
Anterior

43. Spine Injury

44. Spine Injury

45. Spine Injury

46. Spine Injury

47. Spine Injury

48. Spine Injury

49. Spine Injury

50. Spine Injury

51. Spine Injury

52. Spine Injury

53. Spine Injury
• “Rehabilitation means readjustment
and involves body mind and spirit”

54. Spine Injury
Rehabilitation
“There are always ways to compensate for a physical
disability but few ways to compensate for the attitude”

55. Spine Injury
• Urinary function

56. Spine Injury
Pressure
sore

57. Spine Injury
• Bowel function
Avoid imitative laxative
Six rules to maintain
good bowel function
Regular bowel
movement
Using natural reflex
Finger evacuation
Regular Exercise
Plenty of Fluids
Good Diet

58. Spine Injury
• Sex
“Trails in life can be
tragedies or triumphs
depending on how we
handle them, triumphs
don’t come without effort”

59. Spine Injury
• Parenthood
“ It takes other
qualities than being
able to stand and
walk to be a good
parent ”

60. • SPINAL IS FINAL
SCI Prevention -Education

61. Spine Injury Prevention Education

62. Spine Injury Future
• Space age
electronics
Diaphragm
Pace maker
Environmental
control device
Special
Ventilator

63. Spine Injury
“Most important thing is motivation it is all in the mind”

64. Spine Injury
• Recreation

65. Spine injury
• Future
• Transplantation of Human
Neuroteratocarcinoma Neurons in Rats –
Reestablished electrical Connectivity
(University of South Florida,USA)
• Trial of Olfactory Glial Cell Transplantation to
Repair Spinal Cord Injury
(BRISBANE, Australia)

66. Spine Injury
• Future
Research
Cloning
He has his mother's eyes,
father's smile and …….
Stem cell spinal cord

67. Spine Injury
“Learning to live with
paralysis is a tremendous
adjustment but now there
is every reason to believe
it’ll be temporary. Human
trail for effective therapies
for already in a planning
stage are actually under
way. The mottos of the
foundation is ALIVE AND
WELL . We must, we can
and we will”
Christopher Reeve

68. Where Are We???
• From January 2007 we have performed
10 cases
• Team Led by Prof S. Mohanty Principal
• Basic Set Up including instrumentation
• Practically free for patient
• Surprisingly No infection
• Very Good Results

69. Profile of cases
• Spinal tumor
• Extradural space occupying lesion
• Acute disc prolapse in a 19 year young
man
• Failed back syndrome
• Disc prolapse
• Cervical cord compression
• Spinal canal stenosis

70. Spinal tumor
• SKR , 44/m, presented with back pain. Loss of
sensory perception below D11, altered
reflexes,impending muscle weakness
• Plain x rays not contributory
• MRI; evidence of space occupying lesion
D10,D11
• Surgery on 12/3/2007 intradural tumour
enucleated
• Biopsy:schawomma with cystic changes

74. • LS 62/m
• Presented with back pain
• paraplegia below D4
• Loss of sensation below D4
• Bladder Bowel affection
• Plain X ray : showed hazy rarefaction around
d4d5 region
• MRI space occupying lesion around D4 D5with
extension of pathology beyong the confines of
spinal canal
• Exploration on 13/3

75. Case contd
• Space occupying lesion surrounding the
cord extending in the nerve sheeth
extending all around
• Extradural
• Tissue excised
• histopathology :metastatic mucinous
adenocarcinomatous deposit
• patient had subjective improvement of his
sensations .motor power still same

79. Acute disc prolapse in a 19 year
• Very rare
• Traumatic
• PB 19/m history of lifting heavy weight
• Severe pain and radiation in distribution of
S1 dermatome
• Plain X ray :reduction in L5S1
• MRI prolapsed and extruded Disc L5S1

80. • 20/3/2007
• Laminectony and discetomy done
• uneventful recovery
• Relieved of his symptoms and went home

82. • All the cases needed surgery
• All were from the section of society that
are still neglected and require help
• Practically free surgeries
• Cases done without fuss

83. Future………
• Looks positive
• Services and specialities can compliment
each other rather than compete with each
other
• Positive attitude
• TEAM spirit
• Leadership by Example

84. Spinal Cord Injury Prevention- Message
SPINAL IS FINAL !!