What is spinal cord injury
Why does SCI occur?
Spinal cord injury results from either traumatic or non-traumatic insults to the spinal cord. The majority of traumatic cases result from accidents such as motor vehicle crashes, industrial accidents, falls, self-harm, and recreational accidents such as horseback riding, rugby, go-karting, gymnastics, or diving. The elderly are also especially prone to spinal cord injury as their spines (particularly the neck) have bone spurs and bulging discs making them vulnerable to severe injury after even trivial accidents such as simple falls at home. Non-traumatic causes of spinal cord injury include benign or malignant cancers relating to the spine, diseases blocking blood-supply to the spinal cord, or even inflammatory or auto-immune diseases causing destruction of the nerves, such as transverse myelitis or multiple sclerosis.
Despite good labour laws in Hong Kong, classic examples of industrial accidents leading to SCI happen before our eyes regularly. A recent tragic case on New Year’s eve of 2016, where a falling worker landed on a pedestrian. The male worker’s spine injury resulted in permanent paraplegia, and the young 28 year-old female pedestrian’s spine injury rendered her tetraplegic for the rest of her life. Both patients received surgery in QMH and rehabilitation in MMRC.
What are the unmet needs of SCI patients?
Despite decades of advances in surgical techniques and pharmacological management, spinal cord injury has no known cure. Due to their relatively small numbers, spinal cord injury patients have often been referred to as the “orphaned group” of patients. Prolonged hospital stay, high rate of recurrent admissions, home modification expenses, recurrent medical expenses, adaptive equipment, personal assistance costs, cost of institutionalized care, and unmeasured costs of loss of income and productivity, all factor into the devastating and far reaching effects this disease has on the public healthcare system and community at large.
Lack of evidence-based protocols for acute medical or surgical treatment leads to prolonged hospital stay up to years, and increased rate of complications including death. There is a low rate of patient return to gainful employment, and many aspects of rehabilitative care are potentially available but not working in synergistic manner, not linked and not adequately emphasized.
Hong Kong patients suffering from spinal cord injury continue to drive the improvement of SCI rehabilitation.
Left: tetraplegic patient “Bun Jai” – most outspoken for his open request for euthanasia – spends 19 years of his life in a public hospital before finally dying from a complication of his tetraplegia.
Right: paraplegic patient Lai Chi Wai refuses to accept failure, and breaks world record by climbing Lion Rock Mountain while seated in his wheelchair, but is frustrated by lack of support by HA hospitals.
What is the epidemiological picture of SCI in Hong Kong?
According to the International Spinal Cord Society, the estimated annual incidence of spinal cord injury in China is up to 49 new cases per million population per year. In Hong Kong there are approximately 200 new cases per year.
Spinal cord injury epidemiological data (till 2011) from the International Spinal Cord Injury Society
10 year incidence of SCI in Hong Kong
Functional priorities of Hong Kong SCI patients - a research study by the University of Hong Kong Department of Orthopaedics & Traumatology
This survey utilized an online platform to study the opinions of the SCI community in Hong Kong. All participants of this survey were of Chinese ethnicity and cultural background. It demonstrated the varying priorities of functional recovery areas between tetraplegic and paraplegic individuals.
This survey is the first study specifically looking into the recovery and rehabilitation priorities of a Chinese population of individuals with SCI. This is also the first study to investigate the priorities of the primary caregivers of SCI individuals. The findings are useful as a reference for planning of future research and provision of rehabilitation services for the SCI community locally and in other parts of China.
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