Orthopedics & Rheumatology

Biography

Biography: Thisara C Weerasuriya

Abstract

Introduction In the coastal regions of the island nation of Sri Lanka (Ceylon) toddy tapping form coconut trees is a common occupation which is part of the vast industry of production of juggery, coconut vinegar, toddy and arrack( a whisky brewed from coconut sap). The harvesting of the sap is done by toddy tappers who climb these nearly forty foot high palm trees and cross from one tree to another using rope bridges. Falls from these rope bridges are not uncommon as rats that are often attracted to the coconut sap take the same root up the tree and damage the rope bridges that are used by the toddy tappers. Hence falls from these tall trees with resultant spinal fractures is common in the coastal belt of Sri Lanka. I believe that it is important to give a detailed demographic out line of this rather unique problem related to a particular occupation in Sri Lanka. Therefore I think this section should be retained for the information of the readers. Background In Sri Lanka toddy tapping is a common form industry in the coast line villages. Falls from palm trees of forty feet is a common occupational hazard. Spinal fractures are common in these patients . Methods A retrospective analysis of a personal case series of the two authors was undertaken. Results A total of 37 pedicle screw fixations and 58 sub laminar wirings were done during a period of five years from 2004-2009. Follow up time was 6 months to 4 years (mean 3 years). Of the 58 sub laminar wirings, 41 were for lumbar fractures and 17 for thoracic fractures. Thirty two of the 58 sub laminar wirings were for injury due to falls from scaffoldings. Twenty one were toddy tappers who fell off the coconut palms. Five of the 37 pedicle screw fixations were done for thoracic fractures and 32 were done for lumbar fractures. Fourteen patients had falls from scaffoldings. Thirteen posterior fusions of the cervical spine were done. Seven of these were caused by tree climbing accidents. Three patients with sub-laminar wiring developed superficial wound infections while two had to have their metal work taken out due to deep infection. One thoracic sub laminar wiring patient had a CSF leak and two patients with lumbar pedicle screw fixation had cerebro-spinal fluid (CSF) leaks. Three patients with pedicle screw fixations to the lumbar spine had metal work failure due to non-union. One patient with pedicle screws had a re-fracture while three patients with sub laminar wiring of the thoracic spine had pneumothoraxes. Conclusion Sub laminar wiring is a cheap stable method of fixation for traumatic spines which can be used in relatively under- equipped centers as well.