Sunday, February 26, 2012
Quick Surgery Lessons Injury
Neurosurgeon Dr. Michael Fehlings was asleep at his High Park home one night two years ago when his pager went off. A patient with a serious spinal cord injury was en route to Toronto Western Hospital and Fehlings was beckoned to perform emergency surgery.
Time was of the essence, as a study Fehlings was working on then would later show. The study, published online Thursday in the medical journal PLoS ONE, reveals that patients who get surgery within 24 hours of a spinal cord injury have a 20 per cent improvement in their outcomes. Indeed, one in five could walk away from paralysis.
In this case, it had been 11 hours since Anastacia Espena had suffered a serious fall. The 47-year-old nanny fell while taking out the garbage at the Brampton home where she worked, striking her head on the ground. She tried getting up but couldn’t move her arms or legs. The fall had caused a compression in one of her cervical vertebrae.
Espena lay on the ground for 45 minutes, until a neighbour came to the rescue. She was taken to a local hospital and later transferred to the Krembil Neuroscience Centre at Toronto Western where Fehlings is medical director. He happened to be on call that night.
Despite her serious injury, Espena considers herself fortunate. The last thing she remembers before the anesthesia took effect was praying, “Please God, let me walk again.”
Three days after the surgery, feeling began to return to the left side of her body. With ongoing physiotherapy at Toronto Rehab, she continues to make progress. She has gone from relying solely on a motorized wheelchair to a walker. She is now learning to walk with a cane and even without any assistive devices.
The study found that patients are twice as likely to have major neurological recoveries when operated on within 24 hours of injury. Recovery is measured by the internationally recognized American Spinal Injury Assessment Scale. Scores range from letters A to E. Those with an A have no motor or sensory function below the level of injury and those with an E have normal function.
A major improvement is defined by a jump of two or more grades. Espena moved from an A to a D.
“What this means is that some patients are potentially able to walk away from an injury and others are able to regain a lot more independence,” said Fehlings.