Cost Effective & Simple Treatment of Traumatic Lower Cervical Spine Instability.

Abstract

Trauma is a common cause of lower cervical spine instability. This instability of lower cervical spine may result in a serious injury to the cervical spinal cord which may be devastating to the patient with respect to long term disability and suffering. The cause may be fall, industrial, automobile accidents and athletic activities. Cervical spine injuries are usually treated by skeletal traction for 3-6 weeks. This treatment, according to an estimate costs of 40 to 50 thousand rupees though still remaining ineffective in decompression, bony fusion and stabilization. Along with the cost it also gives many miseries to the patient like bed sores, infection etc. [n effluent societies where ideal treatment for the patient takes priority without even a mention of cost the Casper plating remains the best treatment. In our
country this system costs about 30 thousand rupees to the patient. Peroperative this system needs fluoroscopic help for the surgeon which is not available in our theatres. So we as surgeons and our patients still resort to more cheap and simple treatment. This study evaluates cost effectiveness and efficacy of a fixation system consisting of locally made DC plates and cancellous screws which costs only 2000 to 2500 rupees to the patients and needs only a screw driver for the surgeon. This study was conducted in the department of Neurosurgery Lahore General Hospital Lahore comprising of 20 consecutive patients of lower cervical spinal instability due to trauma. There was no fracture or loosening of the implant up to the follow up of 6 months. Excluding the three patients who were in Grade E (Frankel grading), 75% of patients improved their grading to more useful grades. At the end of follow up of 6 months, only 20% of patients were in the non useful grades i.e. A, B & C. There were no complications like bed sore, thromboembolic phenomena, UTI and nonunion of the spine producing chronic instability. It was concluded that lower cervical spinal instability treated by locally made CD plates and cancellous screws is acceptable and cost effective treatment in our patients.