How early is too early? Can we mobilise complete spinal cord lesion patients on conservative management earlier

Author(s): Dr Rashmi Sharma and Dr Arnab Sinha

Abstract: In Spinal cord injury (SCI), the outcome of neurotrauma depends on the quantum of injury suffered by type patients at the time of the actual accidents. We do provide Stability by either providing a fixation or by immobilization. About neurorecovery, we are not sure how much of the recovery is due to the natural recovery of the cord and how much is due to our decompression. Avoidance of complications and thus improving the Quality of Life (QoL) is the foremost important thing in the management. We tried to compare the complications seen on mobilising at 3 week with those mobilised at 6 weeks in patients on conservative treatment. Each of the patients were followed for a period of 8 weeks with serial radiographs taken at the end of every week to see any significant radiological decline. Retrospectively from our records, we chose 20 patients who underwent conservative treatment and were mobilized at the end of 6 weeks (as per convention). On comparing the complications seen on mobilising at 3 weeks with the retrospective study of case records complications seen in those mobilised at 6 weeks, a 20% decrease in the incidence of pressure sores, no incidence of depression (using the Beck Depression Inventory II) as compared to 25% in control group, 30% decrease in pulmonary and renal complications, 100% compliance, significant decrease in bed occupancy and hospital stay was observed in those mobilised at 3 weeks and all these were achieved without any significant radiological decline. 2 patients could not be mobilized at 3 weeks due to pain and were eventually mobilized at 6 weeks.