"Walnut-Spine" - Nonpenetrating Spinal Trauma: An Orchard Hazard In Kashmir

Aims Among the causes of nonpenetrating spinal cord injuries in this snow bound valley, the fall of young and occupationally productive population from walnut trees, has emerged as a new orchard hazard, locally called walnut-spine, which restricts the social and economic development and at the same time increases the social burden of disabilities. We ought to analyze the causes, number, sex, and outcome of nonpenetrating spinal injuries for the epidemiologic purposes, and to project and prevent the occupational hazard such as walnut-spine.Methods The study is based on the retrospective work and data from January 2003 to December 2012 in the Department of Neurosurgery. All the patients with nonpenetrating spinal trauma from C2 to L5 vertebral body level were included in the study. The patients with C1 injury and penetrating causes of spinal injuries such as missiles, knives, nails, iron rods, etc. were excluded from the study. The statistical law of variance was used wherever applicable.Results While analyzing 667 cases of nonpenetrating spinal trauma, it was revealed that the males (526/667 = 78.86%) outnumbered the females (141 = 21.14%) by a ratio of 526 (3.7): 141 (1.0). The most prevalent age group was 21-40 years (403/667 = 60.41%). The most common mode of injury was fall from a walnut tree, called walnut-spine locally, which led to more than half (337/667 = 50.52%) of the total nonpenetrating-type of spinal injuries. The other causes were fall from building heights (222/667 = 33.28%) such as rooftops, windows, walls, etc. and road-traffic accidents (16.19% = 108/667). The most injured segment of the spine was dorsal spine (282/667 = 42.27%) and cervical spine (35.68% = 238/667). The walnut-tree falls alone have emerged as the cause of most of the cervical, dorsal, and lumbar spinal injuries. About 21.28% (142/667) patients had associated head, thoracic, abdominal, and other skeletal injuries. The outcome of walnut-spine was worst in terms of neurodeficits, disability, and mortality.Conclusion A high incidence of walnut-spines - an occupational orchard hazard among nonpenetrating spinal injuries in younger population has resulted in enormous financial and physical costs for an individual and the society.