Ambar Pandey, a 40-year-old farmer from Shivpur village in Uttar Pradesh, faced a debilitating disease after a fall from a height in the field. Multiple falls thereafter led to further spinal cord injury with progressive weakness in his limbs, including urinary and bowel control issues. Imbalance and fear of falling plagued him, along with dysfunctional hands. Numerous attempts at medical care, both private and government-based, yielded no solution.

One day, an individual who had experienced a similar condition shared their journey of recovery with Ambar. This marked his introduction to a rural spine care centre— staffed by top-tier doctors in Mumbai, providing free treatment for the less-privileged. This led Ambar to a hospital in Mumbai, where doctors diagnosed his condition with traumatic Craniovertebral instability—an issue where severe compression occurred at the head and cervical spine junction. He underwent a complex surgery called occipitocervical fusion, covered entirely by the foundation. Remarkably, Ambar showed signs of recovery within the first day after surgery. In two months, he had fully recuperated, regaining the ability to conduct daily activities without hindrance. The lesson learnt here is that prompt intervention helps recovery, but how many in a developing country like ours get this opportunity?

Rafi Shaikh, a 22-year-old from interior Maharashtra, encountered a road accident in August 2021 leading to a three-month ICU stay with paraplegia. He was operated upon locally but no postoperative rehabilitation was instituted due to lack of the facility. After his discharge from the hospital, persistent pain and limited movement remained. Upon evaluation by the spine rehabilitation centre under the auspices of The Spine Foundation diagnosed the need for adequate rehabilitation. Signs of recovery surfaced within two months, and Rafi regained significant neurology markedly improving his quality of life. The lesson learnt is that even if well done, surgery necessarily doesn’t mean a good outcome unless it’s followed by adequate rehabilitation.

Had their issues gone unaddressed and lacked specialized diagnosis and treatment, the lives of Pandey and Shaikh might have taken a drastically different turn.

Spinal Cord Injury (SCI) is a debilitating neurological condition with a tremendous socioeconomic impact on affected individuals and the health care system. More than 90% of SCI cases are traumatic and caused by incidences such as traffic accidents, violence, sports, or falls. Strong inconsistencies in data were noted when analyzed especially in developing countries like India, but the incidence could be in alarming numbers.

A diagnosis can be made through a thorough history and examination. By performing a neurological examination, if possible to participate in a reliable physical neurological examination, for the sensory and motoric functions of the body in the corresponding area of complaints. After the examination, we can make a judgment of the severity and the location of the injury, which is corroborated by relevant imaging like X-rays and MRI.

Timely intervention, medically or surgically whenever warranted has to be Instituted without delay for optimum results and neurological recovery. The lag in this contributes significantly to the failure to achieve the expected goals.

In the absence of timely diagnosis, treatment and rehabilitation, most of these persons are rendered physically, emotionally and financially vulnerable. It is this lacunae that makes the treatment pathway for SCI very ineffective.

Rehabilitation by the use of physiotherapy either manual and/or machine-based is the need of the hour in the period to follow.

September 5th every year, is recognised as World Spinal Cord Injury (SCI) Day. With the overarching theme of access to SCI services, it is worth taking stock of where we stand in India in terms of various spine ailments as well as the availability of and access to spine-related medical care, including in rural and tribal areas.

Furthermore, policymakers and governments should be prepared to invest resources into centres specializing in multidisciplinary care for people with SCI because available systems are likely to become overburdened. This may entail Infrastructural changes at a health-care-systems level to establish appropriate clinical care pathways and improve timely access to quality care, especially for the underprivileged rural and tribal population.

Our experience of treating SCI over two decades in purely rural populations suggests that the underserved rural and tribal areas need a workable and self-sustaining medical service model.

An approach that will streamline patient referrals through village health workers after empowering them with ‘red flags’, equipping Public Health Centres (PHCs), district hospitals, orthopaedic units or RSCCs with primary ‘golden hour’ intervention and escalate and transfer cases to specialized hospitals whenever needed has worked in The Spine Foundation’s network of 13 RSCCs where we have reproduced these pathways which may be reproducible in other areas too.


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Views expressed above are the author's own.


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