I know you’re not a doctor (or if you are, you’re not mine)…yadda, yadda…
I’m looking for opinions, experience, whatever.
As if the family didn’t have enough stress already, my BIL (62 years old, works out, generally good health) was thrown from a horse in Hawaii. The doctor said he crushed his (L1 or L5…whichever is pretty close to the center of the spine) like a Coke can. There are no bone shards to deal with. He had excruciating pain which is now pretty much under control with percocet.
The hospital did MRIs, x-rays, etc, and sent him home (which is really a time share) and told him to lay down for a couple weeks.
No brace
No cast
Needs to fly home for further investigation
I don’t understand! Shouldn’t he be immobilized? How will he fly home from freekin’ Hawaii? Is there any way to lay down on a plane (other than medivac, which I assume this option isn’t even on the table).
What can they do for him once he gets home? Do they create a new “bone” to replace the crushed one? Do they do fusion surgery? Do they insert rods? Could he just heal and be stiff for the rest of his days? It just seems like they’re taking a rather nonchalant attitude toward something that sure seems more serious than “go home and lay down and take percocet.”
That does sound pretty bizarre. Perhaps what he did was to shorten his L1 (the closest to the middle of his spine starting with L) by collapsing some of the porous, foamy-looking bone structure. This is especially easy to do in the middle of the top or bottom face, so that the flat surface the disk used to sit on is now somewhat caved in. I think it hurts because the bone contains nerves but it doesn’t necessarily make the spine or disk work much differently, though the outside of the disk would become a little barrel-shaped to accomodate some of the disk now pressing down into the bone.
I don’t know what the remedy is for that, but guess it might heal without any intervention, except perhaps being careful.
Coincidentally my FIL is going in for surgery Friday for a Fusion and Disk Replacement all in one. He was in a very bad accident when he was in his thirties - some 30+ years ago - so my FIL is of comparable age to your BIL. He recently - last 2 years - has had excruciating pain shooting down both legs…He was taking celebrex and Percs towards the end to just be able to move about during the day. The docs have been stringing him along because of an insurance issue [disk replacement from human donors is apparently still not approved by FDA] and now finally he has come to a place where the surgery is a MUST!
It sounds as if your BIL will be needing a medical procedure of some kind…I’m not a doc so I do not know what he will be needing. But when you flaten the spongy stuff between the verts you are sure to need some kind of follow-up care supplementing the chiropractor.
Remember, from what I understand all surgeries, fusions, rods, etc…etc… are only temp fixes and need to be “redone” after a decade or so. I am not fully sure aboutt hat last part, but it is what I hear. Good luck to him!
I don’t think there is any way to speculate on what will happen without a lot more information, but if it were me I’d have the doctor in Hawaii send my x-rays/MRI results to my regular doctor and ask him or her for advice on how to proceed.
My mother had compression fractures in her back due to osteoporosis. She wore a brace so more vertebrae wouldn’t break, but nothing was ever done about he ones that had broken. She had chronic back pain for the rest of her life.
As such, the idea of not doing anything right now or for a while doesn’t really shock me.
I know they now have his records. I’m not sure if they’re sending another set to the doctor or if they’ll just carry them back.
I spoke with the SIL last night. Evidently, this is SOP for this type of injury. The doctor told him he’ll have excrutiating pain for a couple weeks (currently, going 8 feet to the toilet is a 20-minute ordeal). Then he’ll have moderate to severe pain for a couple months, but they said it is NOT a guarantee of life-long pain (though it could be). He’s 6’1" and 230 lbs; my SIL is like 5’0" and 150 lbs. She said the hardest part is trying to support him while he tries to maneuver to the bathroom.
So… when they get back to the mainland, they’ll be staying with the other SIL, whose husband is a big strapping guy who can help with moving him around until he’s feeling more capable. The big question now is how to actually get him to the mainland without causing more pain. That’s a loooong-ass flight and a lot of airport bullshit to contend with. I don’t even want to think of how uncomfortable that trip will be!
Not a doctor, but a lawyer who sees many back cases. And all of the following is off the top of my head, so I readily defer to anyone with better knowledge and anticipate I will get many things wrong.
Just wanted to point out that there’s a big difference between L1 (top) and L5 (bottom), as a lot more bending involves the L4/5-S1 area. L1 is right below the thoracic spine. Not a whole lot of bending/twisting goes on in that portion of your spine. That’s one reason you hear of so many more problems with the cervical (neck) and lumbar-sacral (low back) portions of the spine.
I’m not sure exactly what it means for a vertebra to be crushed “like a Coke can.” Sounds like a compression fracture, but do you mean crushed across its diameter or from top to bottom? And I believe a term for “no fragments” would be non-comminuted - which is generally a good thing. But with many - if not most - spinal injuries the severity is determined by the neurological involvement - whether bone or disc material is impinging upon the spinal cord. So it is possible that he could really mess up the bony part of one or more vertebrae, but if there were no nerve root involvement and it healed with no significant residual instability, there might be no need for surgery.
Also, it seems that except for the most extreme injuries, surgery is rarely aqn immediate option. Generally a number of more conservative therapies are tried first.
Final non-medical observation. Years ago the prescription for most back injuries was extended bedrest, but more recently the belief seems to have changed to trying to get folks up and active as soon as possible as it seems to hasten their recovery.
Good luck to your brother. A good attitude, hard work and decent overall health will go a long way towards his recovery. Its gonna really suck to be him for quite a while.
I received confirmation that it is indeed L1, so that sounds like a good thing. Also the Coke can analogy is top-to-bottom. The doctor said scar tissue will eventually build up, and because there is no nerve root involvement, that’s probably a good thing as well.
I believe the bed rest thing is just a temporary treatment plan. He’s laying down to give his body time to recover from the initial trauma. I think he’s probably already going nuts without his workout, so as soon as he gets the green light, he’ll be back at it, only “lite.”