Management of the spinal cord injured using a 12-week programme in which patients' relations are involved: a report of 10-year experience

Abstract

Background: There is dearth of designated spinal centers in Nigeria and in Enugu state, there is none. Therefore, spinal injured patients go to teaching and government-owned orthopaedic hospitals to be treated and these are not able to absorb all. Hence, private orthopaedic hospitals are flooded by the spinal injured. Due to this, a 12-week programme of management of the spinal cord injured in which patients' relations were actively involved was initially studied at privately-run Hilltop Orthopaedic Hospital, Enugu for 5years and later expanded to a consultant orthopaedic unit in the University of Nigeria Teaching Hospital, Enugu and extended to10years. The aim is to get such patients quickly back into the society as useful and independent as possible and to see if the outcome achieved in the preliminary study could be reproduced in this extended study. Methods: Staged weekly programmes of assessment and treatment were mapped out to end at the 12th week. Spinal cord injured patients were entered onto the programme as they come. The study was from January 1996 to December 2005. Outcome for each patient was assessed at the end of the 12th week. Results: 256 patients were admitted into the study. 98 patients had incomplete cord injury of Frankel B and C grades while 158 had clinically complete cord injury of Frankel A on admission. 58 patients died on the whole, of which only 2 were from incomplete cord injury. 90 of the incomplete cord injured improved from Frankel B and C to D during the 12-week programme and walked home. From the clinically complete cord injured, 62 were found to still be in spinal shock phase. 16 of these recovered from Frankel A to D and walked by the 12th week. The remaining surviving 86 ended up as permanent cord injured. 82 of these were conversant with wheelchair use at the 12th week. Conclusion: The outcome of this programme is similar to that of the preliminary study. Keywords: spinal cord injured; management; relation involvement