The Stethoscope

It looks like a miracle but it is not.

I have a great story to tell you!

Mr. Man came to see us at the Brain and Spine Surgery hospital early in the year. He was complaining of neck pain, arm pain and weakness of the body. He was finding it difficult to walk and had resorted to using a stick for stability.
We did tests and found that he had arthritis in the neck. This is called cervical spondylosis. He had pressure on his spinal cord (Cervical spondylotic myelopathy (CSM) and we advised that he should have surgery. He said ‘okay’. And we never saw him again!

He then returned recently, worse than before and now in a wheelchair. He had deteriorated significantly since we last saw him and had a sorry tale to tell. He could no longer walk, feed himself or attend to his own toileting. He had to be carried around like a baby.

He said that since we last saw him, he had had many sessions of physiotherapy, acupuncture and more sessions with the Chiropractor. They had all watched him deteriorating but kept asking him to continue. He was now tired of being manipulated, prodded and punctured with sharp needles. Moreover, these treatments had not worked and he was now ready to consider surgical intervention.

We offered him surgery and carried this out immediately. The operation went well and we were pleasantly surprised that he was moving his legs almost immediately after the operation. Sometimes, this type of early recovery makes it look like a miracle but it is not. It is often the result of timely intervention before permanent spinal cord injury has occurred. There is hope for a good recovery and return to a much better quality of life.

Please note though that there are times when delay can lead to permanent paralysis and death. This therefore makes it important for us to tell these stories and educate everyone about this type of condition.

Please read on!

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults in Western society. Very little has been written about it in Nigeria. This would give the impression that it is rare in Nigeria.

Unfortunately, this is not the case and having seen a few patients now in Abuja, we can appreciate some of the real issues. Patients with CSM are not being properly diagnosed and managed. It is often thought to be a disease of old age and part of life. Others feel that old age and infirmity preclude management and so patients are not referred to hospital. Families also at times prefer local management with traditional healers.

Finally, patients are often treated only by General Practitioners, Family Physicians, Physiotherapists, Chiropractors and Neurologists. We have now seen a few patients who have been treated long term for CSM by others without referral for surgical intervention.

Patients having been seen are placed on long term steroid therapy, vitamin C and analgesics and neuropathic pain medicines such as Carbamazepine, Gabapentin and Pregabalin. Our perspective is that such treatment especially for moderate or severe CSM is of little benefit to address the fundamental and underlying problem in CSM. In our opinion, steroid use is not necessary and predisposes patients to diabetes, osteoporosis and avascular necrosis of the head of femur.

The other two key problems in the past were poor availability of MRI scans and spine trained neurosurgeons. This is no longer the case. We now have MRI scans in many places and more capable neurosurgeons who can deliver the results for patients.

Legend : MRI scan showing pressure on the spinal cord.

Surgery remains the last option but it must not be delayed. The operations are also safe with good outcomes in the majority. Surgery performed in a timely manner and before serious deterioration has occurred can be lifesaving. The patient who has had surgery can be returned back to the physiotherapist, the Chiropractor and neurologist for continued management and support.

Legend : The neck operation healed perfectly.

Most patients with muscle stiffness, weakness and paralysis need further treatment and long term care beyond the operation and the other specialists are the best people to provide the care required.

There is a real and urgent need to share the information and for all specialists to collaborate in the management of these patients. Working together will allow us collectively deliver the care that the Nigerian patient so richly deserve.

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