Spinal Fracture

As soon as the aircraft came to rest, I knew that my back had been broken. The pain alone told me that. My neck had been wrenched around in the impact and didn't feel too good either. Fearing the worst, I reached down to feel my left thigh. No skin sensation at all! 'Well, that settles that', I thought, 'I'm a paraplegic! I wonder what level.' Just to make sure, I tried to wiggle my toes. They moved! So I had a spinal fracture with some nerve damage but not a complete spinal cord section. How much, or rather how little, I moved from here on in was going to be critical. I was very glad I was conscious and could prevent any well-intentioned rescuer from trying to pull me from the aircraft! I also resisted the temptation to look around. It hurt too much to do so anyway.

A minute or so earlier, I had selected a field in which to land my glider in appalling weather conditions. A sudden heavy squall had almost literally dropped it onto the power line over which I had been approaching. I had almost cleared it but my wingtip just caught the wire, arresting the aircraft's flight and dumping me thirty feet to the ground below.

Help soon came in the form of a farmer and his son who had witnessed the accident. They didn't attempt to move me but, at my suggestion, fetched some hand tools and started to dismantle the aircraft's instrument panel so that I could eventually be lifted out vertically. I had put out a 'Mayday' call on the radio and another pilot overhead had relayed it and reported back that an ambulance was on its way to the crash site. Being some distance from the nearest large town, though, it could take some time. I indicated that there was no real urgency and went back to the dismantling task with the farmer.

Not surprisingly, the paramedic driving the ambulance knew his stuff when it came to spinally injured patients. Without moving me, cleverly engineered splints were manoeuvred into place alongside my spine and I was firmly strapped to them before the combined efforts of the three people lifted me from the cockpit, onto a stretcher and into the ambulance. I thanked the two who had first assisted me and we set off to the hospital in the regional town some distance away. The ambulance driver took things easily. There was no life-threatening emergency and the least bouncing around the better for me even though I was splinted from head to hips and strapped to the stretcher. In fact, the only parts of my body that I could move were my arms. This was a situation that I would get used to over the next few weeks!

After what seemed a lot of X-rays, taken from a variety of angles, the resident medico gave me his opinion - a fracture at T1O level, probably stable, and another at C5, stability unknown but with no displacement. I had been lucky! A neurological examination had shown some nerve damage (e.g. to the nerve supply to the skin of my thigh where I'd touched it and some paralysis and muscle weakness). I was, however, in spinal shock and only time would tell as to what the final outcome would be and how much function I'd regain. They'd send me off to a ward and call in an orthopaedic specialist.

The effects of the morphine injection were bliss as I was wheeled to the ward on a trolley and carefully transferred to a bed with a fracture board under it. (I had been denied any analgesics until examined as they could have masked my symptoms.) The plastic collar which had been placed around my neck when the initial splints were removed, and sandbags placed on either side of my head, stopped any movement. My only view was of the ceiling above as I contemplated both my luck and my fate, drinking a welcome cup of tea through a bent straw.

An hour or so later, and after some more prodding, probing and examination of radiographs, the orthopaedic specialist they had called in largely confirmed what I already knew - that my spine had been broken in two places, that there was some nerve damage but that I'd probably make a good recovery with little really disabling permanent damage. The thoracic lesion would probably look after itself if kept immobile, but management of the cervical one would require traction. He also indicated that I would be easier to nurse in a Stryker frame - whatever that might be.

I was soon to find out! If you are not familiar with one, it is a bed (of sorts, it's more like a hammock - a canvas sling between the parallel bars of a frame) that you lie on, initially face up. To prevent pressure sores, while avoiding any movement of the spine, you are periodically turned through 1800. This is achieved by placing another bed/frame/sling on top of you. The two are then strapped together and the whole thing rotated (around the long axis of your body) with you sandwiched between so that now you lie face down, head supported by a forehead band and face uncovered. The first (now top) frame is then removed and your back is exposed - initially for a much appreciated rub with alcohol! The reverse procedure returns you to the supine position. The first turn is a buzz, a bit like doing aerobatics in bed!

When face down, you can eat and read, with food or a book on a tray under the frame. Facing up, there was a framed piece of glass behind which you could also place a book. This could be swung away and a mirror substituted so that you could look around the ward. You can't move your head, so you move the mirror around for views of different people etc.. You can also use a bedpan in this position without disturbing things. A small section of the bed under your bottom is removed and you can go without moving (if you see what I mean). Simple!

The turns don't disturb the traction either as it is in line with the long axis of the body - the same axis through which you are turned. Adhesive tapes bandaged to my legs led via ropes and a spreader bar to weights hanging at one end of the frame. Weights at the other pulled on the tongs that had been inserted into small holes drilled into the outer table of my skull. I had talked the medical staff out of shaving my head as they had wanted to (except for where the tongs were inserted) and we settled for a close-cropped haircut instead. I quipped to staff and visitors alike that I was in hospital for a long stretch!

The next few weeks passed slowly. I got to do a lot of reading, listened to a lot of radio and watched a lot of television! One day, about a month later and quite suddenly I found the pain was so much reduced that I didn't need to ask for my regular four-hourly shot of morphine or, indeed, for any more at all (except occasionally when I upset things by moving too much). Milder analgesics would henceforth be generally adequate. The medical and nursing staff said that this rapid transformation to a (relatively) 'pain-free' state was quite common in patients with spinal fractures and with it there came the suggestion that I might be on my feet again soon. The sooner the better as far as I was concerned! It would have to be in a spinal brace though and I would be in one for some weeks to come. 'Who cares?' I thought, 'Anything to walk again!' Assuming, of course that I could.

Face down in the Stryker frame I wondered what it would be like to be upright again as the orthotist took measurements of my back. Two pieces of wet plaster were placed alongside my spine and allowed to set and others were placed around me at different levels. The shape of my spine, pelvis and rib cage was going to be translated into that of the brace. A later visit saw him laying the metal frame of it on my back and making some adjustments. He would soon be back with it completed and ready to try, he assured me. I looked forward to it!

A few days later, the great event came. I was to be transferred to an ordinary bed. I had been taken out of traction Oust to be able to scratch my legs was a wonderful sensation) and I was to be fitted with the brace and transferred in it. Again face down in the Stryker frame, the back part of the brace, now leather-covered, was placed on me, the upper bed attached and, for the last time, I was turned. The remaining parts of the brace, when added, meant that I could be lifted from the frame, with my spine fully supported, and placed on a normal bed. This soon happened, and the Stryker frame, for several weeks my close companion, was rolled away. The orthotist made a few minor adjustments which he explained to the nursing staff. (It wasn't much use telling me as I couldn't see any of it!) Logrolling me sideways (i.e. rolling me with no spinal rotation) allowed the brace to be removed and I lay on what seemed to be the huge expanse of the bed, back in my plastic collar for safety. I was able, then, to examine my new cuirass.

It was a full spinal brace including a cervical extension (we'd now call it a CTLSO) constructed from metal and leather. The posterior part comprised two bars which went either side of the spine from a pelvic band to the shoulders. Another band went around the rib cage. From between the two spinal bars a single adjustable strut went up to an occipital pad. In front was a leather-lined apron' which covered my abdomen and which was attached with three pairs of straps to the pelvic band below and back to the spinal bars above it. Shoulder straps and another two from the thoracic band held a breast plate and from this another vertical strut went up to a pad under my chin. The chin and occipital pads were again joined by leather straps. I counted 12 straps and buckles to hold the thing together! The whole device was superbly made - all polished metal and leather. I suppose, these days, a velcro-closed plastic clamshell with a SOMI attachment or something would do the same job.

During the ensuing day, the head of my bed was progressively raised to guard against the sudden blood pressure loss that otherwise accompanies a long-recumbent patient on first sitting up and getting out of bed. Then, it was back to the horizontal, into the brace and back to the half-sitting-up position again. For the second time, I experienced how firmly the brace was going to hold me. A bit of sideways movement of my head (not much) was all that was possible.

At last it was legs over the side of the bed, sitting on its edge for a while and then, assisted by medical and nursing staff, I got to my feet. What a feeling! I was taller than any of them and it was the first time that my head had been above anyone else's for weeks! A couple of halting (and well supported) steps and that was enough. Back to bed and out of my brace. You couldn't wipe the smile from my face although I felt exhausted by the minimal amount of exercise!

Being in the comparatively wide bed again did have its minor problems. I have difficulty sleeping on my back under normal circumstances (although you don't have the choice in a Stryker frame) and the ability to roll over in my sleep brought a couple of painful awakenings! That night or the next, the sister on duty suggested a remedy for this, that I could try if I wished, that would be effective but which I probably wouldn't like very much. She was right on both counts!

She produced a webbing strap which passed under me and over the lower sheet and which was attached to the sides of the bed out of reach. Joined to this were two fleece-lined cuffs which were buckled around my wrists, holding them fast. Rolling over was now impossible as was practically every other movement above my hips! I was released during the day but similarly strapped down again each night before going to sleep. Later, I learned the technique of sleeping on my side, still wearing the collar, with a pillow between my legs. This aligns pectoral and pelvic girdles and keeps your spine from twisting. Try it if you suffer from backache.

The next few days saw rapid progress. I would walk up and down the hospital corridors, further each time, but with a nurse or a physiotherapist (initially both) holding me firmly. Lying outside in the sun in a recliner was lovely. And I could go to the loo.

After everyone was satisfied that I would be able to cope at home, I was discharged from hospital and, after a few more weeks, I returned to work, still in my brace. One of my colleagues commented that, despite misfortune, I still had my head held high! After a few months of further improvement, I was weaned from the CTLSO but soon found that I would still have to wear a neck brace - at least for a while. Both fractures had healed but there had been damage to ligaments at the mid-cervical level that still required splinting to avoid pain and nerve-root pressure.

After some research of the medical literature, I tried different types of cervical braces with the assistance of an orthotic supplier. (My co-operative orthopaedic surgeon went along with my involvement in the process and was happy to prescribe a brace that was effective and that I could live with.) We settled for a SOMI. This rated quite highly on comfort and was generally effective, but a little less so in stabilizing the neck than my old CTLSO. (Nerve root pressure in extension was and sometimes still is a problem.)

I eventually had a (two-piece plastic) doll's collar made to a plaster cast and found that it gave most comfort and immobilization for the least conspicuous appearance. A total-contact appliance like this really does hold you completely rigid! It's one real disadvantage was that it was difficult to tolerate in hot weather - leading to sweating and skin breakdown. The SOMI went back into service then. The next stage, as things continued to improve, was to wear a plastic or wire-frame open collar (I have both), a soft collar and finally, over a year after the accident, no braces at all.

Well, all that was some years ago. Both fractures healed well and permanent residual nerve damage is minimal, although I have spent stints in traction again from time to time (happily not skeletal traction though). The ligamentous damage to my neck still flares up occasionally and, when it does, I wear the doll's collar while the syndrome is acute. It is still the best trade off I have between firm support, reasonable comfort and appearance (you can hide most of it under a skivvy or turtle-neck sweater). Around the house and to bed (where the appearance of being encased in a radar antenna doesn't matter!), I wear the Minerva brace I have acquired more recently (during the last flare-up in fact), but without its headband.

Hi-tech appears to have caught up with orthotics in recent years and this brace seems to exemplify this to the extent that it deserves a more detailed description from the wearer's point of view. The Minerva's headpiece virtually eliminates extension (unlike the SOMI) and flexion and rotation are similarly restricted. It is, of course, somewhat bigger (having a body jacket) and more visually obvious than either the doll's collar or the SOMI. It practically stops movement of the entire cervical spine and, although this is not really necessary for my problem, it doesn't do any harm either. Comfort for a brace so restrictive is amazingly high and better than practically any other neck brace I have worn, except perhaps for the simple soft collar.

The contact of the headpiece over such a large area from the base of the neck to the back of the head clearly aids immobilization and the chin pad's comfort is similarly enhanced by covering a wide area and hence exerting a lower pressure. Even in hot weather the fabric lining 'breathes' and you stay quite dry next to the skin (or rather the T-shirt or skivvy it's advisable to wear under it). As the recurrence of my problem becomes less acute, I wear the open-frame and soft collars progressively (the last really only as a reminder not to move around too much) until things settle down again.

Well, there you have it - how I survived an aircraft accident and am still walking around to tell the tale. You see that I have accumulated something of a collection of back and neck wear over the years and that I am still glad of some items from it from time to time. I don't, however, recommend the method by which I came to acquire them!

The above story is based on true facts --- Our thanks to the anonymous author for a great job -- we look forward to more stories in the future.

Sincerely,
Binkly

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