Lhakpa Quendren

The increase in traumatic spinal injuries from fractures in the country is exacerbated by the growing number of vehicle accidents (VA), according to a recent study.

The “Epidemiological Profile of Traumatic Spinal Cord Injuries” by Kuenzang Wangdi and his team from the national referral hospital (JDWNRH) reveals that road traffic accidents and falls are the most common causes of spine trauma.

The study, conducted from 2018 to 2020 at the JDWNRH, aimed to evaluate the prevalence, causes, patterns, and demographic characteristics of traumatic spinal cord injuries in the Bhutanese population.

The study included 100 patients with traumatic spinal cord injuries, including 31 female patients admitted to the orthopedic ward between January 2018 and December 2020.

The study found that falls from a height were the most common cause of spinal cord injuries (SCI), accounting for 61 percent of cases, followed by road traffic accidents, which constituted 27 percent of the injuries.

The most common site of injury was a lumbar fracture, making up 42 percent of cases, followed by cervical spine injuries and thoracic spine injuries.

According to the study, the majority of the patients were males, and many of them were farmers in the productive age group of 21 to 40. The study also found that males were more likely to sustain SCI than females.

“The obviousness of males being affected more than females is due to the participation of males in physical activities such as outdoor fieldwork and construction industries,” said the authors.

The study revealed that farmers, labourers, and those unemployed were the three occupational groups at risk of SCI. This increased risk was attributed to the nature of their work, such as climbing trees, cliffs, and negotiating rugged terrain.

The study revealed that most injuries occurred in the younger population, with the most affected group being in the middle-aged groups between 21 to 40 years.

“With increasing age, a greater number of compression fractures were seen in patients aged over 60 years, and most of them had intact neurological status,” the authors said.

The study shows that 63 patients did not have associated cord injuries, while 37 percent of patients had associated SCI. Among those with spinal injuries, 20 percent had a complete SCI, and 17 percent had incomplete SCI.

It was found that patients with complete SCI have longer hospital stays and more complications. “Spinal injuries, especially with associated cord injuries and consequent disruption of neurological functions, significantly affect the patients and families.”

The authors said that SCI has a significant impact on the physical, psychological, and social well-being of patients, resulting in a heavy burden on both their families and the healthcare system.

Traumatic SCI has a tremendous social cost associated with costly healthcare treatment, loss of productivity, and the need for long-term rehabilitation.

However, many traumatic SCI patients had to remain in the acute care ward for their rehabilitation needs due to the absence of a dedicated rehabilitation center.

To reduce the duration of rehabilitation and prevent complications, the authors recommend establishing a spine rehabilitation center. “Understanding the epidemiology of traumatic SCI is very important to help the healthcare system carry out preventive and rehabilitative measures.”

“We can provide valuable education to families regarding rehabilitation and social support, ultimately leading to improved outcomes and better quality of life for individuals living with spinal cord injuries,” said the authors.

In addition, the study recommended collaborating with the traffic and road safety division to reduce road traffic accidents and improve preventive measures.

While a majority of patients with spine injuries did not have associated cord injuries, about half of the patients needed surgical procedures for reduction, fixation, and stabilisation.

While spine injuries are commonly observed in hospitals in the country, especially at JDWNRH, the authors said there is currently no established baseline data on the incidence and range of spinal cord injuries in Bhutan.

Spine trauma is a global health concern, with MVC being the leading cause of traumatic spinal cord injuries, accounting for nearly 39.5 percent of all cases.

The World Health Organisation has stated that MVA will become a major cause of traumatic SCI in the coming decades if effective preventive measures are not taken.