In a matter of moments,a freak accident turned Ludelita Alibuyog's life upside down.
It was a chilly winter morning in January 2016, when the mother of two was roused by her alarm clock. She reached for the snooze button, but instead of stealing five minutes of sleep, slipped off the edge of the bed and fell awkwardly on the bedroom floor.
The back of her neck hit the floor first. It was followed quickly by the rest of her body.
"I couldn't move. I was lying face down. My arms were pinned beneath me,"said Ludelita, 48. "I had some pain in my back, but I began to worry when I couldn't feel my arms or legs. I called out to my roommate and thankfully she heard and was able to get help."
Within a matter of minutes, an ambulance arrived. As paramedics transported Ludelita to Toronto Western Hospital her mind was racing, eventually her thoughts settled on her family – husband Antonio and young daughters Ashley and Fiona – who were half a world away in the Philippines.
Ludelita moved to Canada in 2013 hoping to save money and lay the groundwork for a move by the rest of the family.
"I was so scared," she said. "I was thinking about my girls. They were so far away."
Ludelita didn't know it at the time, but she'd suffered a traumatic spinal cord injury and would require immediate decompression surgery.
Surgical intervention
Fortunately for Ludelita, neurosurgeon Dr. Michael Fehlings – head of the spinal program at UHN and the Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration – was on staff that day at Toronto Western's Krembil Neuroscience Centre.
"The best outcomes for patients with traumatic spinal cord injury occur when there is mild impairment and there is early surgical intervention," said Dr. Fehlings. "Studies show significant improvements for patients who have surgery in this scenario."
After evaluating Ludelita's injury, Dr. Fehlings and his team determined intervention would be needed and performed the surgery in an operating room at Toronto Western.
"We can't say for sure what would have happened if we had not intervened, but there is the possibility that she may not have recovered as well as she did," said Dr. Fehlings. "When surgery does not take place immediately, it's not uncommon for patients to spend more time in a rehabilitation facility or a wheelchair. Some patients are unable to go home at all, while others may require a caregiver."
"It's not hard to calculate all the costs associated with these outcomes."
It's for this reason Dr. Fehlings and a group of spine surgeons, researchers and other clinical professionals from around the globe recently compiled a list of guidelines for the timing and treatment of spinal cord injuries. The findings were published in September in the prestigious
Global Spine Journal.
New guidelines
"Our goal is to have these guidelines incorporated into clinical practice around the world. We strongly believe that doing so will significantly improve outcomes and help reduce costs to the healthcare system."
The guidelines are designed to address two types of spinal cord injury: traumatic spinal cord injury – the type of injury Ludelita suffered – and the lesser known degenerative cervical myelopathy.
"This second condition (degenerative cervical myelopathy) is more subtle and non-traumatic. It's a constellation of conditions caused by degeneration of the discs and the tissues in and around the spinal cord," said Dr. Fehlings.
"The public needs to be aware of cervical myelopathy. It is the most common cause of spinal cord impairment in the world and it is the most serious complication of arthritis. People are aware of hip and knee issues, but often by the time they find out they have this condition, they've already lost a lot of function."
The need for intervention is more immediately clear to clinical staff with patients who have suffered a traumatic spinal cord injury – such as those caused by a vehicle or diving accident – but Dr. Fehlings notes that deploying resources to address those suffering from degenerative cervical myelopathy is equally important – and the sooner the better.
"In recent years there has been a dramatic improvement in surgical technique. Research into the subject – including a tremendous amount performed right here at UHN – has shown surgery is effective in arresting the course of the disorder and improving outcomes for patients."
Road to recovery
Following her surgery, Ludelita spent 10 days in the Intensive Care Unit (ICU) at Toronto Western before she was transferred to the Lyndhurst Centre at Toronto Rehab where she was introduced to the Brain and Spinal Cord Program.
"I was in bed the entire time. The days were long," she said. "Every day they came in and pinched my legs and my arms, but I didn't feel anything. I was really worried."
"Then about two or three weeks after surgery, I felt something in my arm for the first time. I was very encouraged about that. It inspired me to work toward getting back on my feet."
Within six weeks she was moving around in a wheelchair and eventually learned to walk again with the assistance of Toronto Rehab therapists. By November 2016, she was able to walk again without the assistance of a walker.
Then in April 2017, Ludelite was reunited with her children for the first time since surgery when they arrived in Toronto with their father so that the family could live in Canada permanently.
"I was just so glad that they didn't need to see me in the wheelchair or with the walker," said Ludelita. "I was so grateful that day and am today too."
"The nurses at the Toronto Western told me 'You're in good hands with Dr. Fehlings.' I didn't know what to expect. He exceeded all expectations. I was able to walk here today to meet you because of him."
Time is Spine
Dr. Fehlings notes that Ludelita's case underlines the need to put in place clinical guidelines for various types of spine surgery.
"What it boils down to, and it's something we need to get across to the public, is this concept of 'Time is Spine' – the earlier we can intervene, the better the outcomes for patients."
"The cost of treating a patient who has a cervical spinal cord injury can run into the millions of dollars. Immediate surgery is the key to bringing these costs down."
Treatment for patients with spinal cord injuries requires the participation of a multidisciplinary medical team. It can involve both neuro and orthopedic surgeons, nurses, physiotherapists, intensivists, rehabilitation physicians, emergency department staff, as well as family doctors, patients, family members, patient advocacy groups and a variety of other healthcare stakeholders.
Dr. Fehlings and his peers are making a special effort to reach out to each of these different groups to get the message out about the new guidelines and promote awareness of the need to treat degenerative cervical myelopathy.
"It's highly motivating for me and for our team at Toronto Western when we see patients like Ludelita get back on their feet," said Dr. Fehlings.
"It's uplifting for the entire team. Everyone works so hard, there can be a lot of stress involved along the way, the hours can be long, the cases complicated, but when you hear a story like this it just reinforces for you that what you're doing is worthwhile."
Grateful patient
While Ludelita has yet to regain the strength required to return to work, she counts her blessings that the talented spine program at UHN was in place when she needed it most.
"I am so grateful to Dr. Fehlings and the spine team at Toronto Western and also the nice doctors and nurses and other staff at Toronto Rehab who were with me every step of the way during my recovery."
"I don't know if I could have done it without them."
