Last night, my brother was involved in a car accident. What we now know, 24 hours later, is this.
His fourth vertebrae was fractured and pushing on his spinal cord. This has been removed and replaced with some bone from his hip, and covered with a metal plate to keep it in place. There seems to be no further damage to the spinal cord itself, but last night he was unable to feel or move his legs. This was obviously due to his vertebrae pushing on his spinal cord, but what I would like to know is this.
What are the chances that now, in the light of what seems to be a successful operation, the feeling will come back to his legs, and he will be alright? Yesterday, we were told there may be as little as a forty per cent chance of him being able to walk again, but we’ve been told that this is probably a little low, knowing what they know.
I know in cases like this, every individual can be different, but can anyone tell me any more, or direct me to somewhere I can read up on the problems? Forewarned is forearmed, right?
It’s going to be a wait-and-see thing. There may be swelling that goes away, and he’ll be fine. If the doctors told you a 40% chance, that’s their best guess based on what they’ve seen happen before. He may never regain function, or he may in a couple of days, or months, or may regain feeling without being able to walk. If it’s not what they call a “complete” injury, there’s no way to know.
Sorry to hear about your brother and hope he mends soon.
Spinal injuries suck. That’s the plain truth about them. They’re rarely “cut and dried” good/bad type injuries since the nervous system’s still pretty much a “black box” and what may be a devastating injury for one person may be a trivial sore neck for someone else.
From your description, I’m assuming it was his C4 that was broken. It’s going to be a good while just for the trauma of the injury itself and the surgery to go away. IANAD, but do have a collection of herniated discs - there’s probably a fair amount of swelling in that area that needs to go away before the doctors can really get a good appraisal of his condition and overall prognosis.
That 40% figure is really nothing more than a best guess and a desire on their part not to give you an artificially optimistic opinion. In other words, if they say “40% chance he’ll be OK” and he gets back to the way he was last Friday, you’re thrilled and think the doctors are magic. If they say "80% chance of recovery, and he doesn’t recover, you’d think they’re just a bunch of idiots. Truly, at this point, it’s more like “He survived surgery and it looks like nothing really important was cut.” Will he walk again? Probably. Will he be walking tomorrow? Probably not.
The one thing I can’t stress enough with spinal injuries, having been through them, is patience.
Captain Roscoe, I’m sorry to hear about your brother. I have been through a similar situation and wanted to know the same questions you’re probably thinking. I had the spinal fusion surgery as well, and a bruise on the spinal cord, but it wasn’t severed. That’s probably the best news about your brother is that at least the cord wasn’t severed. However, even if it wasn’t severed, the swelling/bruising can be enough to cause a complete injury (no function below the injury level). After five years I haven’t regained much more than some feeling on my lower back. I think the 40% figure is the doctor’s attempt to give your family an idea, even if the doctors don’t know. (I’m not a doctor.)
One of the things people told me is that even when/if function does come back, it isn’t immediate. It’s gradual, and getting things to work again still takes a lot of time and work. It isn’t likely to be something that happens overnight. I hope things work out for your brother and your family.
gotpasswords, it could be C4, but if that was the case, then the injured wouldn’t have much use of his arms, and I think might even have trouble breathing. Feel free to correct me if I’m wrong. I would guess T4, but I doubt that would have been referred to as the fourth vertebrae.
IANAD but I think you are correct. A loss at C4 would cause trouble breathing and would likely lead to loss of most motor function below the shoulder. The physician should have (and likely did) say the fourth thoracic vertebra (or whatever region of vertebra he meant, although only thoracic makes sense here).
Here is a link to an article about myotomes and dermatomes. At the bottom of the article is a link to an enlarged map of dermatomes. A dermatome is a region of skin whose sensation comes from the same spinal level. A myotome is the muscles that are commanded by nerves at a particular spinal level. I was hoping for a myotome map, but google isn’t cooperating. However, the dermatome map is similar enough to give you the general idea.
As has been said, function won’t come back all at once, it will be a slow process as swelling goes down, he heals from surgery, and undergoes rehab. There will be some extremely frustrating days ahead.
Even if he walks again, that doesn’t necessarially mean a full, complete recovery back to the way he was before. He may have numbness or pain in his feet. There may be problems with bladder and bowel control. And some problems with sexual function. I’m not saying this to be pessimistic or frighten you, just to let you know that even in the best cases there are difficulties and phases the injured person goes through.
However, that doesn’t mean he won’t have a full, meaningful life. My husband has a lower spinal injury due to a birth defect. That hasn’t stopped him from getting a job, running his own business, getting married, and he’s even been part of two marching bands. That doesn’t mean he’s tap-dancing, and he certainly has some real problems. Among other things, we have to be very careful because he can injure his feet or legs and not realize it until things get very bad. (He has movement below the knees, but no sensation)
I guess what I’m saying is that while we all hope your brother beats all the odds and has a full, complete, and total recovery - even if doesn’t get that lucky, that doesn’t mean he won’t get better than he is now, or that he won’t have a wonderful life.
Good luck, with an extra helping of patience on top.
It’s too bad board member Brynda is in the middle of a move. She is a psychologist who works in a hospital with spinal cord injured patients, and if I recall correctly, with people who have been newly injured/diagnosed.
I’m sorry to hear about your brother’s injury, Captain Roscoe Here’s a little bit of A&P:
The vertebral column is divided into cervical, thoracic, lumbar, and sacral/coccygeal areas. there are 7 cervical, 12 thoracic (or dorsal), 5 lumbar and 7 or 2 of the sacral/coccygeal, depending on age. ( they fuse as we age.)
Swelling is often a problem after injury or surgery. If the injury is at C-4 which is the fourth from the top, there can be symptoms anywhere below the C-4 dermatome. He may have symptoms of swelling for several days, and they may change. If the neurosurgeon is confident there was no direct injury to the spinal cord, the likelyhood of recovery is good, but not necessarily assured. Swelling, by itself can cause enough eschemia to the cord to leave some impairment. It won’t be set in stone until the swelling has resolved.
C-4 affects the area from the nipple line down. It can involve the diaphram, so breathing can be an issue. C-4 injuries (not just swelling) do need to have ventilatory assistance in the beginning, but may be taught to breathe using the intercostal muscles. The nerve that controls the diaphram, the phrenic nerve comes off the spinal cord higher than the nerves controlling the intercostals.
If the injury is in the low back or lumbar area, as it sounds like from re-reading Captain Roscoe’s post, then we’re talking about L-4.
It sounds like the doctor is giving you straight answers. Give it a few days. He will likely need a good bit of rehab, nontheless.
Well, You all got a little more of the anatomy and physiology than necessary. No extra charge.
If I spelled something wrong or got something out of order, its because this is all from memory. I’ll go find my trauma book in a few minutes, but I’m 99% sure.
Hope this helps. Good Luck.
You have my condolences and best wishes, Captain Roscoe.
Is your neurosurgeon, etc. aware of the medical debate regarding methyprednisolone? IANAMD, but for some years now, there has been discussion of the possibility that early adminitration of prednisone or methylprednisolone could ameliorate/aid healing of spinal cord injuries. See:
This particular cite I found actually presents a skeptical view, but at least, perhaps, you should check to make sure your/his doctor has considered/become aware of this issue, given the time sensitivity.
More generally, for a great source of cutting edge information on paralysis treatment possibilities and research, from a research group doing really good work:
I thought that had been put aside as a waste of effort? I remember collecting data on that in the 70’s that showed no real advantage… newer studies could have different results. I also thought the time frame was within the first hour after injury…
Hmm. The cite I provided was . . . ambivalent on prednisone/methylprednisolone. Not totally negative, though, based on their meta-study. And . . . I guess I was figuring, where is the downside in trying?
Also – my recollection (again, IANAMD) was that the prednisone-related optimism peaked in the early '90s.
Oh, also you are right, most of the studies I recall seeing were keyed to IMMEDIATE treatment (I thought the 24 hour time frame MIGHT qualify), though some were optimistic about later prednisone/methylprednisolone treatment having some efficacy. My theory was: if in a spinal-affecting accident, I’d demand that treatment; the mild (?) downsides of steroidal treatment are far outweighed in the balance by the paralysis-abating potentialities. But, IANAMD, and YMMV.
While the physical effects of short term methylprednisolone are “mild”, the mental effects can be quite dramatic. The dosages used in the case of spinal injury are high enough that in a certain percentage of people it will produce alterations in mental state, including suicidal impulses and psychosis. If the person can’t move I suppose there’s limited damage they can do, but combined with the mental trauma of whatever accident they just had the mental landscape can get nightmarish. Regretably, doctors tend to downplay this side effect, but if you search for threads on this forum mentioning prednisone you’ll get an earful of how it affects one’s mental state.
That said, I’d say a week of chemically induced psychosis would be a fair trade for restoring function to my spinal cord - just keep an eye on me, remove sharp objects from my reach, and don’t take anything I say personally/
I haven’t read all of the responses so far, (but I am so grateful to each and every person who responded) but I can definitely tell you that the doctor said C4, which puzzles me, since you have pretty much all agreed that this would result in loss of breathing function, and possibly some upper limb function. However, I am sure this is what he said. Does this bode well - the fact that his injuries seem to be less that what is actually expected?
Thank you again for all the answers so far, and good wishes. I am constantly praying for him.
Read my first post again. A C-4 injury can cause symptoms from the nipple line down. Not necessarily all the areas influenced by C-4 are injured. Swelling after surgery can also produce symptoms. The symptoms can even change, get better or worse then back again before the swelling goes down.
Yes, it does bode well, but there are still some variables that could change. And, as I said before, if all goes perfectly, he will likely still need some physical therapy/rehab over several weeks to months.
Hang in there. It sounds like the good luck is already in residience.
Captain Roscoe, the most important thing for you to find out right now is whether his injury is complete or incomplete. SCIs are rated on a scale called the ASIA scale. An ASIA A injury is complete, ASIA B, C and D are incomplete. The scale is backwards from grades in school; a D is less severe than a C, and so on.
Complete injuries have a poorer prognosis for recovery. Incomplete injures have variable outcomes ranging from some disablity to none.
Regardless of his injury and the likelihood of neurological recovery, your brother can lead a good life. Rehab is important, and there are advances in technology that can allow him to do quite a bit for himself.
