Medical Advise - broken back

Hi K. - Ages ago my husband was in a car wreck and "broke" his back, but, the emergency staff who came to the scene thought he was dead and didn't treat him. After he regained consciousness, he got out of the wreck himself and walked to a house to call his parents for help. The injury was right at the waist line (not sure which numbers those are) and broke off part of a vertebrae rather than snapping the column. The break was obviously bone only and never was treated. He recovered on his own but still has trouble from it almost fifty years later. Not sure if that will help or not. Puma

Rapid decelerration injuries can cause spinal contusions at sites other than where you have definable fractures, plus when you add in a concussion, all manner of temporary effects might manifest. As far as fractures go, they are in the simplest terms divided into stable and unstable. Stable fractures would include compression fractures of the body of the vertebra and fractures involving the various processes (bony projections) which will cause significant pain but are "stable" for walking, meaning you won't suddenly just fall to the floor paralyzed if you turn the wrong way. Unstable fractures involve the ring of bone that encase the spinal canal and could involve bone shards or shifting of the spinal column resulting in permanent nerve damage. Also the pain can be a lot worse than what you see on an X-Ray and bad enough pain can result in temporary paralysis (as far as the patient is concerned...a neurologist might do some nerve conduction studies down the road if the paralysis persists)

A serious fracture at L1 or L2 could cause paralysis from the waist down, maybe even a bit higher. If you want to confine the paralysis to the hips and legs, make it L4 or L5. Counting starts from the top down, so the L1 is actually a couple of inches above the waist.

Maybe I'm wrong, but to my understanding any damage to the spinal cord that causes paralysis isn't recoverable.

I broke my spine and right hip when I was 10 and walked away from it. It was a 30 foot fall and broke the spinous process (the little finny part of the vertebrae that sticks up).

When I was 20 I fractured my atlas and axis vertebrae in a car accident. My arms were paralyzed as a result of the accident, but not from the broken neck. The paralysis came from soft tissue damage in my shoulders. I got very limited use back after about a month, and recovery plateaued for a year or so with me having weak/tingly/numb arms and hands. They still aren't as strong as they were before, but I can pretty much do what I did before except play violin for long periods of time. A couple of neurologists have told me that I should completely recover from that over time, as nerves will regrow at a rate of 1/4 inch a year, or so.

Lastly, a good chiropractor is magic. That is all.

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Canotila said:

Maybe I'm wrong, but to my understanding any damage to the spinal cord that causes paralysis isn't recoverable.

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That depends upon how you define damage. Edema and inflammation can cause temporary dysfunction that can manifest as paralysis. The spinal cord is part of the central nervous system. As a general rule, the central nervous system does not regenerate. A bruised whatever is not the same as a transected whatever and so sometimes people get better, not because they truly healed, but that the doctors overestimated the degree of what would be permanent damage.

That makes sense about the inflammation. When I picture a damaged spinal cord, I imagine a situation where it has been pierced or severed somehow. Does the cord itself swell? Or is it tissue around the cord that swells and compresses the nerves?

Canotila said:

Does the cord itself swell? Or is it tissue around the cord that swells and compresses the nerves?

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Yes, both

As one poster said, L1 or L2 would be too high. A spinal cord injury there would lead to symptoms from the high waist down. If you want just legs and hips, pick L4 or L5.
Then, about cord injury: a severing would lead to permanent paralysis and numbness (not to mention incontinence, etc), so if your MC is to recover, it better not be severed. You want a temporary compression of the cord instead. A burst fracture would fit the bill nicely. That way the cord (oh, by the way, the spinal cord itself ends at approximately L1-- below that level, it's called the cauda equina) can be compressed by inflammation and bone bits, but can be decompressed either surgically (usually with a lumbar fusion) or with bracing, depending on the severity of fracture. Here's a handy little summary along with a few good links...
http://en.wikipedia.org/wiki/Burst_fracture
I don't know what your MC's age is in the book or during her accident, but if she's an adult now, she's going to have ongoing stiffness and/or pain even if her neurological problems were resolved. It's a major injury, and no amount of PT or chiropractic treatment (which would have been started at approximately 8 weeks post-trauma if there was no surgery, 12 if there was, typically, and nothing vigorous at first) is going to entirely cure the problem, only palliate it.
Best of luck!

Hi Karen--
Traction in the lumbar spine (along with casting, called a body jacket, for 2-3 months) isn't useful in directly healing a cord injury-- when it's used, it's only to set the fracture. Traction's also used in certain lumbar disc problems, but that's not your hypothetical situation.
If your MC had paralysis due to bone compression and not just temporary traumatic cord inflammation, they would have to do surgery to decompress the cord pretty quickly, or she'd have permanent damage. In that case, she'd have a fusion, along with screws and rods or cages (they may be removed later, well after healing).
If it was determined that no bone or other stuff was pressing on her cord and the spine was stable, and the paralysis was purely due to traumatic swelling, they would probably stick with traction and immobilization, although some hospitals fuse where there is any neurologic deficit.
Hope that helps!