HealthThe Stethoscope

Managing patients with paralysis.


The patient

She complained of neck pains that radiated down the arms. The pains were at times sharp like knives and other times a dull deep bruise. It would happen at a moment’s notice and often whenever she moved her neck. Moving the neck caused pain, yet she was compelled to move the neck which aches with stiffness.

The numbness crept up slowly till she could not hold a spoon without finding it on the floor. She just did not feel it in the hands even though she could see herself holding the spoon! In time, the power in her hands started to reduce and it got harder to hold her phone. The legs soon followed. Initially, they felt stiff and would often move on their own accord. A snap forward like a conductor’s stick. In time, they became heavy and difficult to move necessitating the wheel chair.

Many pastors, soothsayers and herbalists were called. Many prayers were said. Lotions, potions and motions were taken to no avail. Alas, it required divine intervention.

The neurologist

This came in the form of a simple referral. A referral to the neurologist was indeed the beginning of a solution to the problem. When patients have problems with weakness, numbness affecting the arms and legs, the problem is often in the neck.
Pressure on the spinal cord in the neck can lead to paralysis. They require an MRI scan of the neck to determine what is wrong and where in the neck. The neurologist requested for an MRI scan which showed there was indeed pressure on the spinal cord in the neck. The spinal cord was being squeezed to death.

The neurosurgeon

The friendly neurosurgeons at the Brain and Spine Surgery Consortium were called and they agreed to see the woman with pain in the neck and paralysis. She was carried into the clinic in a wheel chair. Her hands were weak, and the legs were swollen. She needed an urgent operation as they advised. The cost of the operation was a few million Naira and the family promised to bring her back for the operation. They had to raise the money first. ‘We don’t want to owe the hospital money’, they said. Unfortunately, she died before the funds were available!

Cervical Spondylosis

Arthritis in the bones of the neck is called cervical spondylosis. This means wear and tear due to age or injury to the bones and joints in the neck. It can lead to weakness of the arms and legs due to pressure on the nerves and spinal cord. It can lead to difficulty in breathing and death.
When it is bad and causing pressure on the spinal cord, an operation is required, and this should be carried out as soon as possible. Wasting time as we sometimes do in Nigeria, leads to more damage and poorer outcomes.

Good outcomes

The operation is often simple and safe for the majority. It is done under general anaesthesia and lasts perhaps only a few hours. The recovery from anaesthesia is short and most patients do very well. Many also notice immediate improvements in the feeling and general awareness of their hands and legs. The weakness takes a bit longer to improve. Numbness also takes a long time to improve.

We have had clients who improved to independence after a few months and some after years. The real value of the operation, however, is that the deterioration stops immediately after the operation. Once the pressure on the spinal cord has been removed, the damage to the spinal cord stops. This leaves room for improvements to occur over the weeks and months.

Information

This article serves to provide current information for the general public and especially medical doctors including orthopedic surgeons and physiotherapists. Spine operations have improved in quality and we now boast of much better outcomes than before. Continuing conservative management in a patient that is visibly deteriorating should no longer be tolerated.

There are now skilled operators in many centres in Nigeria. The surgeons are delivering better outcomes and the results (published) are as good as 90-95%. In effect, up to 95 out of 100 patients coming for spine surgery have a good outcome and return home safely.

Of course, we cannot ever boast of 100% good outcome as we are not the Almighty God! There will always be some complications and even deaths in hospitals. However, there has been so much improvements that death and disability are now few and far between.

Trust us

So, the sky is the limit. But first we must counter the myths and misconceptions. It is vitally important for Nigerians to trust the spine surgeons in Nigeria for assistance. We have improved significantly and are improving still. We will continue to deliver better outcomes as we get more patients, perfect the procedures and gain more experience. We will be able to help more people and the cost of the operations will reduce even more. Currently, the operations are way cheaper than going abroad but could be lower still.
If you give us a chance to help you!

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