Introduction

Epidemiological factors of spinal cord injury in Indian scenario are different from western countries with major cause being fall. The low socio-economic status and younger age group had a major financial, social and psychological impact as majority of the patients were the primary earning members of the family. According to a study (Mathur N et al .2015), among 2716 cases of Spinal cord injury, 1400 were cervical and 1316 thoracolumbar, with male to female ratio of 4.2:1 and 71% in the age group of 20-49 years. Around 79% patients were from rural background. About 23.3% were farmers while 22.9% were laborers. Among the causes of injury, 53% patients had a fall from height and 28% suffered from road traffic accidents. Fall of heavy object over the head and back (10.7%), fall with heavy object over the head (3.0%) and fall following electric shock (4.0%) were uncommon causes. Complete paralysis was found in 20.5% cervical and 23.3% in thoracic injuries. Extremity and rib fractures (10.6%) and head injuries (7.2%) were common associated injuries. About 55% cases were initially attended at non-specialized centres. Proper bladder and bowel management in early phase was lacking. However according to another study conducted at Indian Spinal Injury Centre, New Delhi, the mean, median and mode for the age were 34.4, 32 and 30 years, respectively. Male: female ratio was 5.9:1. RTA was the most common (45%) and fall from height the second most common (39.63%) mode of injury. Overall, 66.67% suffered from paraplegia and 71.18% had complete injuries. The study suggests that the demographics of spinal injury in India differs significantly from that in the developed countries since there was a lower mean age, much larger number of males, married individuals, injuries due to two-wheeler accidents/falls, paraplegics and complete injuries.

1. A comprehensive classification of thoracic and lumbar injuries. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. Eur Spine J. 1994; 3(4):184-201.
2. Advanced Trauma Life Support. American College of Surgeons 1997.3
3. Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. Wood KB, Khanna G, Vaccaro AR, Arnold PM, Harris MB, Mehbod AA. J Bone Joint Surg Am. 2005 Jul; 87(7):1423-9.
4. Combined anterior-posterior surgery versus posterior surgery for thoracolumbar burst fractures: a systematic review of the literature.P Oprel P, Tuinebreijer WE, Patka P, den Hartog D. Open Orthop J. 2010 Feb 17; 4():93-100.
5. Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial.Bailey CS, Dvorak MF, Thomas KC, Boyd MC, Paquett S, Kwon BK, France J, Gurr KR, Bailey SI, Fisher CG. J Neurosurg Spine. 2009 Sep; 11(3):295-303.
6. Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review.Thomas KC, Bailey CS, Dvorak MF, Kwon B, Fisher C. J Neurosurg Spine. 2006 May; 4(5):351-8.
7. Demographic profile of traumatic spinal cord injuries admitted at Indian Spinal Injuries Centre with special emphasis on mode of injury: a retrospective study. Chhabra HS et al. Spinal Cord. 2012 Oct;50(10):745-54.
8. Julio C Furlan, Vanessa Noonan. J. Neurotrauma.2011 Aug;28(8):1371-1399
9. Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting.Tropiano P, Huang RC, Louis CA, Poitout DG, Louis RP. Spine (Phila Pa 1976). 2003 Nov 1; 28(21):2459-65.
10. Functional outcome of burst fractures of the first lumbar vertebra managed surgically and conservatively.Butler JS, Walsh A, O'Byrne J. Int Orthop. 2005 Feb; 29(1):51-4.
11. Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Chow GH, Nelson BJ, Gebhard JS, Brugman JL, Brown CW, Donaldson DH. Spine (Phila Pa 1976). 1996 Sep 15; 21(18):2170-5.
12. Functional outcome of thoracolumbar burst fractures without neurological deficit. Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP. J Orthop Trauma. 1996; 10(8):541-4.
13. Management options in thoracolumbar burst fractures.Hitchon PW, Torner JC, Haddad SF, Follett KA. Surg Neurol. 1998 Jun; 49(6):619-26; discussion 626-7
14. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing.Cantor JB, Lebwohl NH, Garvey T, Eismont F. JSpine (Phila Pa 1976). 1993 Jun 15; 18(8):971-6.
15. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures.Ni WF, Huang YX, Chi YL, Xu HZ, Lin Y, Wang XY, Huang QS, Mao FM.J Spinal Disord Tech. 2010 Dec; 23(8):530-7.
16. Scoliosis Research Society. Multicenter spine fracture study.Gertzbein SD Spine (Phila Pa 1976). 1992 May; 17(5):528-40.
17. Short segment fixation of thoracolumbar burst fractures without fusion.Sanderson PL, Fraser RD, Hall DJ, Cain CM, Osti OL, Potter GR. Eur Spine J. 1999; 8(6):495-500.
18. Spinal cord injury: scenario in an Indian state. Mathur N et al. Spinal Cord. 2015 May;53(5):349-52.
19. The three- column spine and its significance in the classification of thoracolumbar spinal injuries. Denis F. Spine 1983;8:817-
20. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Mumford J, Weinstein JN, Spratt KF, Goel VK. Spine (Phila Pa 1976). 1993 Jun 15; 18(8):955-70.
21. Thoracolumbar "burst" fractures treated conservatively: a long-term follow-up.Weinstein JN, Collalto P, Lehmann TR. Spine (Phila Pa 1976). 1988 Jan; 13(1):33-8.
22. Wood K, Butterman G, MEHBOD A . J BONE JOINT SURG 2003 ;85A:773-81

Dr Vishal Prakash

Junior Resident, KMCH Katihar, India