A 52-year-old taxi driver was suffering from chronic back pain from 10 years. During the last 3 years, his back pain became progressively worse and developed numbness in both lower limbs.
Following the consultation of neurologist at a hospital at Kandy, a computed tomography (CT) was done in 2012 and diagnosed as infective spondylitis at D5/D6 level of the dorsal spine. It was identified as Pott's disease (spinal tuberculosis). Anti-tubercular therapy (ATT), was given for 1-year period. After ATT, the patient was unable to walk without support. After that, he was referred to neurology unit. While he was in neurology unit, he suffered accidental fall from the bed causing him unable to move his lower limbs, but his sphincter control was intact (sensory intact with motor defect). Repeated CT of dorsal spine showed D5/D6 fracture [Figure 1a]. Since his condition did not improved, he was asked to take follow-up at the rehabilitation unit for conservative management, which was continued up to 1 year at rehabilitation unit. Observing no improvement, the patient decided to seek Ayurveda treatment starting from June 2013.
At the time of reporting for Ayurvedic consultation and management, patient complained of a heaviness and numbness over lower body and difficulty to move his legs. He could not bend and raise his lower limbs. The patient was treated using three treatment regimens while assessing the outcome at the end of each regimen.
Treatment regimen 1 (1-6 months): Sheethodaka oil (30 ml) with paste of Katakaladi (Bridelia retusa [L.] A. Juss) was applied externally over the fractured area. Triphala decoction (30 ml), Vasa-Guduchi decoction (120 ml) and Gandharva-Hastadi decoction (120 ml) was administered orally twice a day, for first 3 months of this phase [Table 1]. After 1 month and when the patient showed first signs of improvement [Table 2], simultaneously passive exercises were started. Active exercises were started later, when further recovery was noted
Treatment regimen 2 (6-12 months): Triphala decoction (30 ml) treatment was continued for next 6 months in the same dose similar to first 6 months. In addition to that, Pinda oil (30 ml) with paste of Katakala (60 g) was applied topically daily. Dantimooladi decoction 120 ml was administered twice a day in the first 3 months of this phase. In the second 3-month period, Dashamoola-Bala-Eranda decoction (120 ml) was given. The patient recovered from symptoms of numbness and heaviness along with gaining ability to move his lower limbs
Treatment regimen 3 (12-24 months): During this period, Tarpana Chikitsa which was continued throughout 12-month period along with application of Narayana oil (30 ml) with paste of Ashwagandhadi (60 g), externally. Maharasnadi decoction (120 ml) was administered twice a day at initial 3 months of this phase and after that Masha-Baladi decoction (120 ml) was started twice a day for the remaining 9 months.
The fractured bone was immobilized using lumbar thoracic corset. It was applied throughout the day in the 1st year and after that until the treatment concludes it was applied over the day time only. Altogether, after 24 months of commencing initial treatment, the patient recovered completely.
Seethodaka oil was prepared according to the classical text of Ayurveda Pharmacopeia. Pinda oil and Narayana oil were prepared according to the classical text Bhaishajya Ratnavali. Triphala decoction, Vasa-Guduchi decoction, Gandharava-Hastadi decoction, Dantimooladi decoction, Dashamoola-Bala-Erandadi decoction, Maharasnadi decoction and Masha-Baladi decoction were prepared according to the guidelines and methods mentioned by the classical text of Ayurveda Pharmacopeia.
Paste of Katakaladi and paste of Ashwagandhadi were prepared according to the guidelines of Sri Lankan traditional physician family of "Arangala Veda Parapura." Preparation of paste of Katakaladi: 240 ml of juice extracted from bark of each drugs Bridelia retusa (L.) A. Juss. (Katakala), Syzygium cumini (Linn) skeel's (Jambu) and root of Hemidesmus indicus (L.) R. Br. (Sariva) and 30 g of each powdered rhizomes of Zingiber officinale Roscoe (Shunthi), fruits of Piper longum Linn (Pippali), stem of Coscinium fenestratum (Gaertn.) Colebr. (Daruharidra), pericarp of Terminalia chebula Retz (Abhaya), Terminalia belerica Roxb (Vibhitaka) and Phyllanthus embillica L. (Dhatri) were added together and heated over mid fire until a semi solid paste is obtained. Preparation of paste of Ashwagandhadi: Powder of Withania somnifera (L.) Dunal. (Ashwagandha, 60 g), powder of Vigno mungo Linn (Masha, 30 g), Cinnamomum zeylanicam blume (Twak, 15 g) and powder of Syzygium aromaticam (L.) Merr. and Perry (Lavanga 15 g) were grinded with 120 ml egg white and mixed with 60 ml of honey to obtain semi-solid paste.
Images of CT scan of fracture site before [Figure 1a] and after the Ayurveda treatment [Figure 1b].
Motor function assessment with the time, after commencing the Ayurveda treatment [Table 2].
Quality of life was assessed before the treatment, 1 month, 3 months, 6 months, 1 year, 18 months and 3 years of the treatment. Quality of Life was assessed by the ferrans and powers quality of life index (FPQLI) spinal cord injury version-III.
At the commencement of treatment, the total quality of life score was 84/420. Following 3 months, the 4 subscales increased significantly (P < 0.05). After 24 months of commencing the treatment, the patient recovered and the total score of FPQLI became 410/420 (P = 0.02) [Table 3].
Statistical analysis was conducted using Wilcoxon signed rank test. Statistical software SAS version 9.1 (New Jersey, USA. 2005) was used for the analysis. Initially, from 1 to 6-month period, the parameters were compared at 3-month intervals. After 6 months, until completion of treatment, it was compared at 6-month intervals.