Indian Spine Journal (Jan 2018)
Socioeconomic impact of cervical spinal cord injury operated in patients with lower income group
Abstract
Background: The socioeconomic impact after cervical spine surgery in patients with cervical spine injury have not been reviewed. The aim of this study was to analyze the clinico-radiological results and socioeconomic impact even after radiologically successful surgery. Materials and Methods: One hundred and thirteen surviving individuals (out of 166) were included in this retrospective study from hospital record who belonged to lower socioeconomic group as per Kuppuswamy scale. All patients had undergone cervical spine surgery (anterior or posterior) for cervical spinal injury from 2007 to 2014. The injury sustained was either purely traumatic or trivial trauma in an existing cervical myelopathy. Average income per family was Rs. 2215.13 ± 870.46 ($39.55) per month with cervical spine injury who underwent surgery. Pre- and postoperative Oswestry Disability Index, Kuppuswamy score, and Nurick Scale were used to assess the degree of loss of function in individuals and roentograms for fixation assessment. The individuals were contacted on phone or during hospital visit to evaluate their expectations and daily living. Results: The average age of study group was 46.65 ± 16.89 years with 65 (57%) comprising males. Fifty-one (46.7%) patients were laborers or farmers, 24/47% lost their jobs after injury. About 19% (Rs. 414.9 ± 162.89) of the monthly expenditure was spent on their rehabilitation and medicines and 63 (56%) had expectations to get government support in the form of financial help or rehabilitation. The Nurick scale did not show any significant change in pre- and postoperative periods (3.06 vs. 2.83; P = 0.180). The postoperative Oswestry Disability Index score was not significantly decreased as compared to the preoperative stage (82.4 ± 1.8 vs. 78.2 ± 2.9 P > 0.05). However, there was a significant reduction in the Kuppuswamy score in the postoperative period (12.5 ± 2.5 vs. 8.2 ± 1.5, P < 0.05). Despite good radiological results and improvement in the clinical symptoms, the socioeconomic condition of the individuals deteriorated in the study group. Conclusions: These findings suggest a socioeconomic impact after cervical spine injury. Cervical spine surgery alone does not make sure of a good functional outcome for the patients of spinal cord injury. It also required a good rehabilitation program which is always a challenge in the lower socioeconomic group, hence socieconomic status of an individual, possibility/ availability of rehabilitation program should be kept in mind to predict/ prognosticate the outcome.
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