Thoracic Park

Thoracic Park

A tale of spinal injury

If you’re nearby when a head, neck, or back injury is sustained, treat it very seriously and call for help. A simple lesson in common sense, or so you may think, but the majority of the population wouldn't immediately recognise the problem, never mind know how to react. Despite being a nurse, even my own response to encountering a spinal injury displayed little common sense.

Throughout the 90's cycling had gradually replaced running as a way of keeping fit and enjoying our beautiful countryside. After treading both the fells and road for many years, knee damage and back injuries left few options for replacing the sense of freedom offered by running. In those days I trained for marathons, regularly covering more than 100 miles each week. I enjoyed the challenge of competition, completing the Skiddaw fell race in 80 minutes, and a marathon in 2hrs 40.

However, running gradually became too uncomfortable and failed knee surgery finally put paid to the addiction. So, to get a fix of adrenalin, I'd learned to love both road and mountain bikes. It was a new way of life for which I soon developed a passion.

We lived in the fabulous wilds of Argyll: Minard, a tidy village on the shores of Loch Fyne, lying midway between Inveraray and Lochgilphead. It's Sunday morning - the glorious 12th of August - and I've been up since the crack of dawn fitting new front suspension forks to my mountain bike. I've never used suspension before and it feels great, although the handling is dramatically different. That unfamiliarity with fork suspension before tackling a tough ride may have been unwise, but I had good company following my very fit son, James, along one of our regular routes.

It's a calm day, the sun's shining over a glassy Loch Fyne and the world looks more beautiful than ever. The boy's quick today. He's getting quicker every time we ride together and I'm working hard to keep up. Highly competitive, he races at junior national level and handles the bike exceptionally well. Heading downhill toward the calm loch on a deeply rutted stretch he begins to pull away. Catching him seems beyond me, but despite gradually losing ground I'm determined not to be beaten. I'm forcing myself, going ever quicker and taking risks to keep up, but my lack of skill and the new suspension...

Suddenly, on a narrow, steep chicane, the front wheel slips away. I desperately try to hold the steering, but get thrown head-first into thick undergrowth. It takes but a millisecond till I feel a searing pain and hear an ominous crack in my neck. James rushes back to where I lie, winded and concussed despite the bike helmet. Deeply concerned, he asks if I’m okay. Pushing aside the dented pride, I tell him my left arm is near useless. Getting to my feet, I manage to throw a leg over the crossbar and cycle home.

Despite being one-handed I try hard to ignore the injury and clean the car. Not content with that, I also do some garden weeding. But the pain gradually becomes excruciating. My wife pleads with me to call the doctor, but I'm in denial and ignore her. She works in neurophysiology in Glasgow, and fearing the worst, wraps a towel around my neck to restrict head movement and prevent further injury. Although I don't realise it, I'm but a millimetre of fractured vertebrae from severing my spinal cord and total paralysis. It'll take just one wrong move.

After an uncomfortable night, Allison pleads in desperation for me to get help, before reluctantly leaving for work 70 miles distant in Glasgow. After she's gone I think hard about the options. Trying not to panic, I decide to let work know I'm not fit to travel since my arm's useless and my neck has swollen making head movement impossible. Meanwhile, a spinal injuries consultant with whom my wife works, tells her to phone home and advise me to get immediate help. Now, living in rural Argyll has many advantages, but one of those is not your proximity to emergency medical care.

Checking the time, I realise a bus is due that will take me to the nearest medical help in Lochgilphead. With jarring pain firing through every stride, I jog down the rough track from our hillside home to catch the speeding brute before it leaves. As it leans through tight bends I wince and hold tightly onto the seat. When it finally reaches the town, I carefully walk up the hill to the cottage hospital where I'm immobilised and catheterised. As I'm their Director of Nursing I sense this is causing muted hilarity. No matter, within the hour one of the local GP's has arranged an airlift to the Spinal Injuries Unit in the Southern General Hospital in Glasgow.

The short helicopter trip ends in my wife's place of work. I'm grimacing sheepishly as she greets me on the helipad. Within a few minutes an x-ray shows a fracture of the third cervical vertebra. Although the spinal cord has been nipped, I'm relieved to hear it's not torn, or the consequences could have been very serious. After three days in hospital I’m sent home for a week to wait for the swelling to recede before a scan can be done. When I finally return, the consultant shows me the print of the scan. It looks like a star with fracture lines radiating out from its cord-protecting core. I’m shocked at how close I am to total paralysis. After discussing the options with the medical team, I opt to wear a neck supporting body-brace. It's like scaffolding and doesn't look pretty. Despite scaring some children and fascinating others, it allows the fractured vertebra to heal normally. Surgical pinning, the other option, would have solved the problem immediately. Surgery, however, with the insertion of a supportive metal coil, creates a greater risk of arthritic changes developing in later years.

To explain how serious this situation was, it may be helpful to outline the potential damage such injuries can cause. Vertebral bones in the neck and back (the spinal column) are easily fractured. It doesn’t take a major trauma. A young guy in hospital had collided with the ground when his kids' swing wasn’t strong enough and the rope snapped. At first his children thought he was joking when he told them he couldn't get up. Another patient in the spinal unit had fallen back from the first - yes 1st - step of a ladder while stacking shelves in his own shop. He'd felt a sharp pain on landing then tried to get to his feet, but couldn't. Simple actions; devastating results.

Vertebrae provide a conduit for, as well as protecting, the fragile and sensitive spinal cord which transports vital messages from our brain to and from the limbs and organs. Any break, tear, or distortion in the cord will prevent the clear transmission of those important messages. Fracturing one of the spinal bones and damaging the chord can therefore result in partial, or total paralysis of the limbs. The most affected areas of the spine are those of the upper cervical spine and mid-torso thoracic vertebrae. This is possibly because they are smaller and more prone to extreme flexion due to their exposed positions.

According to recent figures, two people a day in Britain suffer a spinal injury. Recent estimates put the total number of spinal cord injured at between thirty-five and forty thousand people in Britain. The level and severity of damage determines the degree of paralysis, or loss of muscle controlled movement. 'Nipping' the chord between two vertebrae can cause a loss of sensation in one limb. Minor injuries can often be resolved with treatment. However, the other extreme - severing the chord - leaves irreparable damage. In general terms, the closer to the skull anyone's chord is affected, the more serious the impact on the limb movement and a person's general physiology. In perhaps a worst-case scenario, we can be left with tetraplegia - paralysed from the neck down. This sometimes requires artificial support for respiration.

It is reckoned that life expectancy is reduced by no more than ten per cent following spinal injury. Many people, in fact, live long and active lives regardless of the problems their injuries create. However, quality of life can be more adversely affected by the psychological damage sometimes associated with such injuries. Others are left with life-long, debilitating pain, yet still pursue fulfilling, active lives.

A fracture in the upper part of the cervical spine is, in layman’s terms, a broken neck. There are seven cervical vertebrae supporting the skull. If we cut the spinal cord at this level the impact can be terminal, although a complete shear usually results in tetraplegia, or neck down paralysis. In such cases, life-long personal support is usually required to maintain health and hygiene. However, a raft of adaptations is now available to dramatically improve the quality of life.

In relation to someone with ventilated (breathing assisted) tetraplegia, I had the good fortune to meet a true survivor. He was a climber; a man who loved mountains. After selling his business, he decided to fulfil a lifelong ambition and tackle some of the more remote peaks in the Andes. Following a hard days climbing, he'd returned to his hotel room without meeting anyone before settling in a for a well-earned nights rest. Too tired to be bothered eating, he decided to retire to bed. In the early hours he got up to visit the toilet, but had forgotten the small step between the ensuite and his bedroom. Missing his footing, he'd tumbled over the step and struck the coffee table with his head, breaking his neck and severing the cord. Unfortunately, no one knew he'd returned. Paralysed and gasping for breath, he had lain alone for nearly 24 hours before concerned hotel staff broke into the room and discovered his plight. The German hotel owner tried to get help, but the weather had closed in and no emergency flights could reach their remote location. Taking matters into his own hands, he secured the paralysed climber to the floor of his long wheel-based Land Rover, then drove some forty miles over tortuous tracks to the nearest town with a hospital!

Once repatriated to the UK, the injured climber spent more than a year in Sheffield's Queen Elizabeth Spinal Injuries Unit until his house could be adapted to meet his needs. During his prolonged stay, the man taught himself to write using a breath-driven scribing tool for his laptop and had an article about his injury published in the local Sheffield newspaper.

Lower level injuries can be caused by damaging one of the twelve thoracic vertebrae helping support your torso down through your ribs to your waistline. The outcome of fracturing these vertebrae is usually a degree of paraplegia, or paralysis from the waist down. The lumber vertebrae lie below the thoracic level, but don’t tend to cause quite so many problems. This may be due to their safer and less flexible positioning on the spinal column, possibly even aided by their larger size.

Dysfunction following an accident can include a loss of bladder and bowel control. The bladder is often left with its sphincter muscle in spasm, inhibiting the free passage of urine. This can cause damage to the kidneys due to back-pressure via the ureters, although the bladder is usually tested thoroughly before leaving hospital. Due to staff changes this didn’t happen in my case and I suffered renal damage before the situation was recognised and corrected.

The effects of spinal injuries on a man or woman’s relationships can also be problematic. For some, living with the physiological effects of a spinal injury on their partner can be difficult, if not impossible. This is true for both the sufferer and their partner. Any life-changing injury often causes personality problems. For many the change in body image and function is difficult to come to terms with. These problems often take time to resolve. Before leaving hospital, I was advised that it could take as long as five years to adjust to the psychological changes brought about by an injury. From experience, I cannot disagree with this timescale. Long-term psychological support, however, is available both from within and out with the health service for those who want, or need it.

An individual's sexuality is also challenged. Male or female, there is a change in body image to adapt to, as well as varying degrees of mobility loss. It has to be said here, that there are now so many possible adaptations available for daily living, that most of those suffering spinal injury can survive admirably in any environment without assistance. In my case, this included managing perfectly well on my own living in a small caravan in France. During the two years it took to renovate and convert a ruined barn into our home I also supervised the work to ensure it met my needs.

For men, there is often difficulty in achieving and sustaining erections; for women, an absence of vaginal lubrication. Again, there are many different ways, medicinal and mechanical, for overcoming sexual problems. Both sexes may experience an absence of physical sexual sensations, but there are numerous solutions to enhance and stimulate a partner during sex. Incidentally, there is no reason why those with spinal injuries cannot have families. Many well-known spinal injury cases, male and female, now live happily with growing families thanks to IVF.

It must be said, that surviving and thriving post spinal injury is a uniquely individual experience. It is often dependent not only on the injury, it's severity, and the supporting resources available, but the adaptability, courage and determination of the injured person. Initially such serious injuries can seem beyond even the strongest and most competitive of us, but where there's a will, there's a way for most of us whose mobility and lifestyles are compromised.

*This blog is a personal piece done as a broad layman's overview. It in no way attempts to describe, from a clinical perspective, every type of spinal injury, or disability and dysfunction caused by those injuries.

Rob Brown is T4,5 PARAPLEGIC, having been struck by a car while cycling in Sheffield. The injury occurred one year after accidentally breaking his neck as described here. Lucky to be alive, he never forgets how good fortune can shape your life.

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