Ramblings on healthcare, medical education, and life with a spinal cord injury
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Details on My Injury and Surgery

What follows is detailed information about my specific injury.  If you’re not interested in the gory details, you can skip this one without missing anything about the journey itself.  But if you want to learn how much the spinal column and cord can move and still retain some resiliency, read on.

My injury is a subluxation of C7 over C6.  The American Journal of Neuroradiology has an interesting article that explains how subluxation presents, which helps provide an idea of how my injury may have looked.

Effectively what happened was (and if I get my child-like drawing skills ready, perhaps I can provide a visual of this – I stopped after image googling through a number of pages), my C7 vertebra broke from the posterior point of attachment on the spinal column, slipped anterior to the column and then slid back in superior to C6 (we’re unsure if C6 also broke from the posterior part of the column as well – it seems like it might have).

This is obviously not a good situation.

Not only is it bad because of the subluxation itself, but the extreme movement causes the spinal cord to be stretched fairly significantly out of its normal pathway.  A good way to demonstrate just how mangled the cord gets is to borrow a person (you will need their fingers) and a piece of string (thin cords, such as headphone cords, shoelaces, etc also work just fine).  Here is how you can see:

  1. On one of their hands, have the individual make a ring with the thumb and index finger.
  2. Have the other individual suspend the string through the ring formed by his or her fingers.  The ring represents C5 in my injury (one vertebra higher than injury level).
  3. Now make a ring with each of your hands around the string below theirs.  Your top fingers represent C6, and the bottom represent C7.  Although it may not look it, pretend all three vertebrae are in the same orientation.
  4. Decide which directions represent anterior and posterior.
  5. Now the injury: slip C7 out of the column anteriorly, and back into the column above C6

Note the distortion of the cord, the stretching, and the scissoring action between the vertebrae.  Frightening, isn’t it?  This is the demonstration my neurosurgeon, Dr. Ashok Anant provided to my girlfriend (yes, that is him in the #1 spot of the neurosurgery list in New York Magazine’s Top Doctors 2007 – I was truly blessed to find him at Lutheran at 4am early on a Monday).

The first thing Dr. Anant tried upon bringing me into the OR was to apply traction to my head.  The hope was that the traction would cause C7 to come out of the column and slip back into its proper place without surgical intervention.  I was under a local anaesthetic at the time, and they attempted a surgical halo with fifteen pounds of traction.  Part of applying the halo is making sure it is firmly attached to the head, so screws were hand-driven into both sides of my skull.

I’d always wondered what it felt like to have halo screws driven into my skull.  Not that this was a good way to find out, but it was interesting nonetheless.  I didn’t feel any pain at all, but you do feel the pressure of the screws boring into your head.  And the sound.  I thought the sound was actually pretty interesting and, dare I say, cool.  It’s somewhat of a grinding sound, as you would imagine, but feeling the pressure and knowing screws are going into your skull just inches from your brain is quite an experience.

Unfortunately, the traction didn’t work.  C7 would slip out of the column once traction was applied, but instead of slipping back into its proper spot, it would just slide back in between C5 and C6.  Surgery was a necessity.  Needless to say, I don’t remember the rest.  I now have scars both on the front and back of my neck – the one on the back is much more complicated.  Thirteen staples closed it, and at this point it is a zipper of sorts.  A long line on the middle with thirteen descending dots on each side.

I was told they had to flip me over from stomach to back several times (four?) during the procedure in order to actually get the vertebrae all in the right place.  The procedure took seven hours, and I now have several titanium rods and a cage anterior to my spinal cord.  They will remain for the rest of my life, as structures will form and grow around them.  And no, they won’t set off airport metal detectors.  Granted, the wheelchair just might.  Maybe.  Possibly.

My column and cord are now properly aligned and bolted into place.  I was finally allowed to take the cervical collar off after four weeks, on February 26th.  The collar is secondary to the titanium in my neck, and was primarily to keep me from any extreme motion in the weeks following surgery.

With the surgery behind comes the real work: rehab and recovery.

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