Rural spine surgery practice: Challenges in optimal management of traumatic spinal cord injury

Study design: Prospective observational study. Objectives: To highlight the challenges in the management of traumatic Spinal Cord Injury in rural spine surgery practice. Setting: Agartala Government Medical College, Agartala Tripura India. Methodology: Consecutive spinal cord injury cases were admitted from September 2018 to September 2019 in the department of orthopaedics and surgical stabilization with pedicular screws system with or without decompression was carried out. Results: 44 patients with SCI were treated with 34 males (77.27%) and 10 females (22.72%) majority of the patients were between the age group of 31-40 years (40.9%). Fall from height being the common cause of SCI the patient were brought to the hospital emergency at 1 day to 7 day in 61.36% and in 45.5% of the cases SCI patients were transported to the hospital on relative arrangement in 45.45% of cases CT evaluation was carried out at 1day to 7 days and MRI evaluation at one week to one month in 59.09% of the cases. Time to surgery was between one week to one month in 61.6% of our cases and 40.45% of our patients belonged to low economic families. Conclusion: Comprehensive management of SCI is a big challenge in a resource-challenged rural area needs a collaborative effort by the government for improving the practice of spine surgery in rural settings. Imbalance still exists in the availability of the specialized spine care between urban and rural areas. Families with low socio-economic status had a major financial, social and psychological impact as majority of the patients were the primary bread earning members of the family and hence emphasis should be on proper utilization of the available Government health schemes for addressing the financial constrain families in rural set ups.