Dangerous Climb

Most of the spinal cord injury cases received by hospitals come from traffic accidents or fall from the walnut trees, with the maximum number of cases coming in the harvesting season. Saima Bhat reports

Nisar Ahmad, 20, had an accident when the bike he was riding was hit by a truck on national highway near his home. That moment changed his life, for ever. He became immobilized for life.

“It happened for the first and the last time. I couldn’t see the pacing truck coming towards me. It was destined to happen,” says Nisar, who seems to have given up hope.

His father Abdul Rahim says, “We brought him to SKIMS Soura directly as his condition was very critical.”

He had loss of sensation and functioning of lower part of body. He was not able to move his limbs and was having difficulty in breathing. After preliminary investigations doctors found out that he had developed fracture and dislocation of upper spinal vertebrae.

A doctor treating Nisar said, “He was first stabilized and when his spinal cord injury was confirmed by CT and MRI scanning, he was put on cervical traction for immobilization of spine. The patient was taken for surgery where stabilization of spine with the help of prosthetic instrumental pallating was done”.

A spinal cord injury is a medical emergency requiring immediate treatment to reduce chances of irreparable loss. The time between the injury and treatment is a critical factor affecting the eventual outcome. Recovery of some movement or sensation within one week usually means the person has a good chance of recovering more function, although this may take six months or more. Losses that remain after six months are more likely to be permanent.

Nisar has become completely bed-ridden with immobilized lower body. Nisar is a 2nd year BSc student.

Doctors are discharging Nisar from the hospital and have advised his father to arrange an air mattress and a wheel chair for him.

“Just a couple of months ago I used to scold him for remaining out for long hours but now I wish he could walk, I wish  he could stand on his feet again,” says a distraught Rahim. Nisar is put on indwelling urinary catheter to drain urine.

Spinal cord injuries are mostly caused by road accidents, fall from height, bullet or blast injury, tumors, and can be also caused by infection, diseases and disorders. A spinal cord injury can result in either total disruption or transition of cord, compression or contagion of the cord resulting in total or partial loss of body functioning below the level of lesion which can be either temporary or permanent.

In case of total transition of cord the loss of function is permanent and cannot be reversed by surgical or medical intervention. While as in case of compression or contusion of cord the loss of function may be reversed in only some cases.

Adil, 25 years from shopian was admitted in Bone and Joints Hospital (B&JH) two weeks ago. He had a fall from walnut tree. He says, “It was continuously raining from past few days, I thought of climbing the walnut tree so that rain may not affect walnuts. Such trees are very slippery and during rainy season they become even more slippery. I had a slip when I was about to upper side of tree”.

Adil was brought to the hospital where he was diagnosed with injured lumbar – lower level of spine. Since then he is lying on bed and doctors have not recommended any surgery.

Dr Asif Sultan, a consultant in B&JH says, “We gave him medical assistance he needed but in such case no surgical intervention is needed as the spine is already cut/ ruptured, there is no mechanism of stitching the cord so there is no fun in for a surgery”.

Doctors say such patients can’t be kept for a long time in hospitals as there are a limited number of beds and patients load is quite heavy so these patients are sent home. But they are asked to be on regular follow ups and consult a physiotherapist.

A doctor in neurosurgery department at SKIMS says, “Management of spinal cord injury should begin at the site of an accident, there should not be any kind of mobilization to injured spine as it can further damage the nervous system and sometimes this becomes the reason for on spot death”.

During summer unrest of 2010, B&JH and SKIMS, both received a number of patients who were hit by bullet on their spines. In such cases recovery chances are less or no chances as the bullet burn whole area, spine where it gets struck so comparatively the chances of recovery are zero compared to the spine injury cases by fall.

The Bone and Joints Hospital received around 200 spinal cord injuries from January 2011 to October 2011. While 25 per cent of the patients had cervical spine and were shifted to SKIMS for treatment, rest were treated at the B&JH.

Dr Asif says they mostly get the patients in walnut harvesting season, who have a fall from high-trees, under-construction buildings or from windows. Most of the spinal injury cases are males in the age group of 18 to 40 years.

SKIMS usually receive cervical spine injury cases besides other spinal injuries. But the exact number of such patients was not available in SKIMS. “We keep the records of those patients only who are admitted in wards. But there are a number of patients who come in emergency section and if they have cut in the spine (paralysis) with no other complication they are discharged from there only,” a doctor not wishing to be named said.

A social activist who works for the welfare of the handicapped said that Proper guidance and support should be given to the people whose livelihood is related to climbing the heights.  “Government should also provide insurance cover to workers who are vulnerable to such tragic accidents like those harvesting walnuts, construction workers, stone quarry labourers,” he said.

A doctor at the neurosciences department of SKIMS said that most of his patients are from poor backgrounds. “They also need physiotherapy support which can make them understand how to live with their disabilities.”

Doctors say there are no preventive measures for such incidents.

“They should be given new techniques by which falls can be minimized as maximum numbers of patients received in both the hospitals are of during the walnut harvesting season, like they can be given ropes as is done in various states of India,” he added.

Composite Regional Centre (CRC), Srinagar, established in 2000, is the lone rehabilitation centre for disabled in Kashmir. The CRC is supposed to take care of disabled persons and train people in rural areas to handle the seriously injured.

“The CRC has failed to make people in rural areas aware about handling the seriously injured people. CRC has been limited to providing wheel chairs and monthly funds to such patients but most of the patients don’t even know they can get monetary and other assistance from the centre,” an aid worker said.
The private run Khyber hospital, in collaboration with Indian Spine Injuries Centre (ISIC), organised a two-day free medical camp for patients with spinal cord injured on May 21, 2011. Around 300 patients visited the hospital on those two days, which included patients with arthritis and osteoporosis.

Administrative Coordinator Khyber Hospital, Shahnawaz, says that they are planning to get more spinal specialists in valley so that the patients get benefited.

The impact of spinal cord injury varies depending upon the level and type of injury. Injuries near the top of the spine result in more extensive disability.
Spinal cord injury is of severe type when involving upper or proximal spinal level as compared to lower spinal level.

The upper spinal level injury involving cervical level can compromise respiration and can lead to death. There occurs loss of body functioning below the level of lesion which may include loss of sensory and motor functioning (paralysis), bowl bladder control and making patient susceptible to develop a chain of multiple secondary complications which include bed sores, atrophy or wasting of muscle mass, infections including urinary tract infections (UTI, so the patients are advised to perform bladder catheterization from time to time) and psychiatric disturbances.

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