A prototype of a purpose-built cervical spinal-reduction bed that was constructed in his garage by a former registrar in the spinal unit at Tygerberg Hospital and his colleagues, drew lots of attention at the recent Innovation Indaba.
“We were faced with the problem of cervical dislocation. It’s a devastating injury when associated with spinal cord damage and paralysis. But, if dealt with appropriately and quickly, a better result can be achieved,” Dr Johan Davis, former head of the spinal unit at Tygerberg Hospital, explained the need for an improved intervention in this type of injury.
“Where resources and skills allow, you would do a rapid surgical intervention. But, with limited availability of surgical capabilities or theatre time in most centres, a closed-reduction manoeuvre can win time by removing the pressure off the spinal cord until you can fix it more permanently.”
This type of injury is usually caused by car and sports accidents, as well as interpersonal violence.
The clock is ticking
“Most of these injuries occur in young males – typically aged between 25 and 35,” added Dr Sanesh Miseer, current head of the unit.
“With a dislocation, the spinal column is kinked, causing pressure,” he continued. “You have to increase the dimensions of the spinal canal to reduce this. The quickest, most efficient way is via a closed reduction.”
The faster the pressure is reduced, the better the outcome. Traditionally this meant using callipers, pulleys and weights, a difficult achievement in busy emergency rooms with limited trained staff.
“This can be cumbersome and uncontrolled,” explained Dr Delmar Badenhorst. “A bed is not always available and it’s a mission to get the equipment together. My turning point was when 30 kg weights fell on my foot while I was performing a reduction.”
Badenhorst, then a registrar in the unit, had an engineering background and set out to develop a purpose-built cervical spinal-reduction bed in his garage under the guidance of Davis. It is a uniquely designed cervical traction bed, built specifically for cervical spinal injuries.
The Charles Oppelt case
A driving force behind this project was the case of Charles Oppelt, a young sportsman who was paralysed by a rugby injury. In 2015 the Constitutional Court ruled in the Oppelt case that these injuries must receive reduction-type interventions within four hours. The hype around the case heightened awareness and urgency.
“There is an onus on clinicians to deal with this as quickly as possible,” said Davis. “The spinal-reduction bed is one way to tackle this challenge.”
The bed has since undergone some refinements and the current prototype won a prize at the recent Innovation Indaba.
“But, importantly, it was seen by the Premier of the Western Cape, who was very supportive,” said Miseer. “Discussions are underway to purchase beds for more state hospitals.
“Obviously an ongoing challenge is to get a patient to the bed quickly,” he continued. “We are identifying provincial centres of excellence where people are trained in the protocols and techniques of the reduction, and know when and where to refer patients to. The more you can limit the players in the referral pathway, the better your chances are of reducing the time.”
Davis added that the long-term goal is to have the bed available at casualty hubs countrywide.
All three pointed out that the mechanics of the traditional method remain sound.
“If done in time by skilled people the success is similar, but the bed makes it faster, particularly in resource-limited environments,” said Miseer. “It simplifies the process, increasing the enthusiasm for this work.”
State hospitals attend to most of these injuries and the programme at Tygerberg therefore emphasises training and innovation.
“The impact of this innovation is life-changing. The financial and emotional burden of paralysis is enormous. We have seen patients presenting with potential paralysis who walk out of hospital,” said Badenhorst.
“The bed is a game-changer and if we can get it to more trauma centres, it can have a huge impact.”
‘With a dislocation, the spinal column is kinked, causing pressure. You have to increase the dimensions of the spinal canal to reduce this. The quickest, most efficient way is via a closed reduction. – Dr Sanesh Miseer
Photo credit: Stefan Els