How surgeons rebuilt shattered spine

Published: July 1, 2005  |  Source: new.edp24.co.uk
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The shattered spine of 25-year-old Matthew Hunt.
The shattered spine of 25-year-old Matthew Hunt.
Matthew Hunt will walk again thanks to the skill of a Norfolk surgical team. Health Correspondent MARK NICHOLLS looks at how they re-built his shattered spine.

One moment Matthew Hunt was driving to work in his car, the next his whole life hung by a thread after he lost control and ended up in a field.

When paramedics discovered him soon after 7am on May 23, his feet were hanging out of the front windscreen and his bottom was through the sunroof.

He had not been wearing a seatbelt and had been catapulted around the Peugeot 309.

He had a cut ear, punctured lung and a broken shoulder and ribs. Yet more seriously, his spine was horrifically fractured and dislocated.

As is standard practice at such a crash, ambulance crews made an assessment of the extent of his injuries, established the strong possibility of spinal damage and then cautiously removed him from the wreckage using a long board to minimise movement and risk further damage.

It was 25-year-old Matthew’s good fortune that he was taken the regional spinal injuries unit at the Norfolk and Norwich University Hospital and into the care of Consultant Orthopaedic and Spinal Surgeon Mr Am Rai.

“When I looked at the x-ray the first time I saw him, it essentially showed a fracture dislocation of the spine,” said the surgeon.

“In my experience, and that of a number of other senior surgeons, that would almost always result in complete paralysis and that is what I was expecting to see.

“But I was very, very surprised to see normal neurology.”

Matthew was assessed, showed he could move all the different muscle groups and his sensations were also intact.

The x-ray revealed he had fractured the Vertebrae in a number of places but the spinal cord was undamaged.

“This is extremely rare, we are reporting it as a one-off,” added the surgeon.

Yet while Matthew was lucky to escape unparalysed from the crash, despite his horrific spinal break, the greater challenge lay ahead for the surgical team to repair the damage without causing further neurological injury.

“That made it more difficult to treat than someone with complete paralysis.

“If you have a fracture dislocation like this, usually there is no way you would be able to walk with that,” said Mr Rai.

Experts from a number of different specialisms met to discuss the case, MRI scans were carried out and a team brought together to operate and reduce the fracture of the spine.

The operation, eventually to last up to six hours, took place on May 25.

“The delay was to make sure we had everything in place and that we were doing the right thing,” explained Mr Rai.

The team led by Mr Rai consisted of a registrar, Senior House Officers and general medical staff, a consultant anaesthatist, theatre nurses, radiologists and a neuro-physiological team.

In the early stages of the operation an incision was made in Matthew’s back so that the spine and, more importantly, the cord could be identified.

Because of the risk of damage being caused during surgery – a risk that was explained to Matthew beforehand – a special monitoring system was put in place.

This involved putting monitors on his brain, attaching electrodes to the spinal cord and stimulating the muscles of his foot at regular intervals to measure his response.

In this way surgeons could assess whether they were causing any damage to the spinal cord and in turn respond to any changes.

This is a technique used by N&N surgeons when correcting Scoliosis – curvature of the spine – but it is believed this is the first time such a technique has been used at the hospital in a fracture case.

A “scaffold” with screws carefully inserted into bone above and below the break was created before the surgical team realigned Matthew’s spine and spinal cord.

A “cage” and artificial disc was then built around the break as it heals – one that will remain in Matthew permanently. Matthew will also have to wear a supportive brace around his mid-riff for three months.

Mr Rai, who has been at the N&N for four years, is pleased with the outcome.

“It is an excellent outcome, we have treated a patient with a significant injury, it is very rare with this degree of displacement not to have neurological problems.

“But we would hope that within six months he will be able to resume normal activities.”

Matthew, who works for Country Homes at Eye assembling mobile homes, remembers little about the crash or events of May 23 but recalls having his ear stitched and his clothes cut off.

But he adds: “Some time during the day I realised that I had broken my back and I was in quite a lot of pain, I thought I was going to die.

“I then thought that I was never going to walk again.”

Yet through the success of the operation, Matthew has been able to walk out of hospital.

And with every step he takes from now on, he will remember with gratitude those in the medical profession who saved him from certain paralysis.