My Surgery

It snowed on Christmas Day in Raleigh. It wasn't your classic White Christmas since the snowfall did not start until late on Christmas afternoon but it was the closest this Southern boy has ever come to a White Christmas. On the day after Christmas, I went out for a walk in the newly fallen snow. It was wonderful. Few cars had passed. The snow was ankle deep and soft, giving excellent traction. I have been walking regularly for exercise for years and that was as good as a walk could get. I remember passing by a neighbor who was shoveling her driveway. I called out with the standard Southern advice for snow -- "Don't bother shoveling! It'll melt!"

By the next day, December 27, much of that snow had melted. I decided to go out and walk again, which was a terrible mistake. I got about two blocks from my house before I slipped and fell on ice. I fell straight back landing flatly on my shoulders. My immediate reaction on hitting the icy asphalt was relief that the impact did not hurt. Unfortunately, I quickly realized that I was in no pain because I could feel nothing below my neck. I could also move nothing below my neck. As bad as that sounds, it does not quite convey how dire things seemed. I looked to my left and saw something close by that I could not immediately identify. I soon realized that what I saw was my left arm stretched out at shoulder level. I had thought it was by my side. The left arm that I was looking at did not even seem to be part of me.

I called for help. My neighbors were ensconced in their warm houses and could not hear me. It took a few minutes before someone drove up. In those few minutes, I started feeling pain in my shoulders. Sensations of the cold, cold pavement that I was lying upon were entering my buttocks and legs. I began to wiggle my fingers and toes. I was even able to think about trying to get up but quickly realized that I could not get up on my own and that any attempt to do so would be insane.

I have been asked many times how long the quadriplegia lasted. I have told people that it may have been two to six minutes but that I was certainly not looking at my watch and that my perception of time was probably skewed by what I was experiencing.

An ambulance finally arrived. I was placed on a body board and taken to the emergency room. A technician tried to check my temperature on arrival at the emergency room. The thermometer did not register. He muttered that it must be broken and got another one. It did not register either. He got a third thermometer which finally registered. I was not told what it showed but the technician immediately got some warm blankets and put them over me.

Many x-rays and MRIs were done. They showed one thing which I already knew, that I did not have a head injury. They also showed to my surprise that I did not have any shoulder injuries even though as time passed at the emergency room, my shoulders hurt more and more. The MRIs of my cervical spine showed much pre-existing arthritis, spondylosis to be technical, that was constricting my spinal cord although there was no appearance of acute spinal stenosis, that is, pinching of the spinal cord.

I was regaining sensation and movement the entire time that I was in the emergency room -- about nine hours. By the time I was released from the emergency room, I was in a lot of shoulder pain, I had pain in my rubbery arms and legs, I was exhausted, thirsty and hungry but I was able to button my shirt and tie my shoes, which was extremely encouraging. I still felt terribly, terribly cold.

I was told to make an appointment with a neurosurgeon, which I did. The neurosurgeon looked at the MRIs and said that he could see no damage to my spinal cord but said that it took time before spinal cord damage shows up on MRIs. He said that my cervical spine looked to be tight around my spinal cord but not tight enough to require surgery. Still, he implied that I might need spinal surgery in the near future, saying that my spinal cord first needed time to heal. He ordered a course of oral steroids, which he thought should have been given to me at the emergency room, and physical therapy. The steroids helped a lot but the benefit ended soon after they stopped. The physical therapy helped me keep up my strength and range of motion.

Things began to settle down. I had pain, numbness and weakness in both shoulders, both arms and both legs. My symptoms were patchy and variable. None of it was acute. It was just that the symptoms covered so much of my body.

I was supposed to go back to my neurosurgeon on April 14. By early April, I called to ask that my appointment be moved up because my symptoms were rapidly accelerating. It took some time to get in to my neurosurgeon's office. In the meantime, new MRIs were ordered. When I finally got to my neurosurgeon's office, I was told that he had been called out of town due to some unspecified emergency and would not be back for two weeks but that I could see his physician's assistant (PA). The PA had an odd look on his face when he came in the room. He did an extremely hurried exam and seemed to expect every abnormality he found and he found a lot. He showed me the MRIs which he had looked at before examining me. My spondylosis had accelerated. Also, and even more important, I now had a badly herniated disk at C3-4. My spinal cord was obviously compressed at c3-4 to the point that it was perhaps one-quarter of the diameter above and below that point. The pinched portion of the spinal cord looked nearly white on the MRI. The PA told me that was dangerous. He informed me that I could not wait until my neurosurgeon returned to town, that I must see another neurosurgeon as soon as possible.

I saw another neurosurgeon the next day. He recommended that I have a C3-4 anterior cervical diskectomy and fusion (ACDF) and soon. He told me that I also have significant problems at C7 and to some extent at C4-6 but he felt those did not require surgery now and might never require surgery.

I had the C3-4 ACDF surgery last Friday. I was home by Saturday afternoon. My throat is awfully sore. Having an anterior fusion means the surgeon goes in through the front of the neck, having to navigate around the trachea, esophagus and larynx which do not appreciate being disturbed, any more than the cervical vertebrae appreciate having screws drilled into them to support a titanium plate.

My neurologic symptoms are fluctuating but I have seen much improvement. No one can say where I will finally end up but I am confident that I will be much better than I have been since December 27. In any case, but for the surgery I would have been in a wheelchair or worse within a few months.

I had never heard of a fall producing a temporary paralysis. I have found out since that while rare this is far from unknown. This sort of thing is most commonly seen in football. This is a major reason for the current rule requiring that tackles be made with the head up since tackles with the head down put a player at greater risk for spinal cord injury. Remember that I never thought that I had injured my head in the fall? That was because I had instinctively flexed my neck forward so the back of my head would not strike the pavement. That may have saved me from a terrible head injury but it also put me at greater risk for a spinal cord injury.

I have heard a couple of theories about how this sort of temporary paralysis happens. One theory is that the violent slamming of the spinal cord damages the myelin that surrounds nerves much like the insulation that surrounds electrical wires. Another theory is that the violent slamming temporarily disrupts the blood supply to the spinal cord. No one knows.

To readers who wonder why my symptoms did not correspond to the nerve root dermatomes, they are so familiar with, I had and have myelopathy, not radiculopathy; damage to the the spinal cord itself rather than to one or two individual nerves branching off from the spinal cord. Dermatomes are irrelevant when one is talking about myelopathy. You just do not see much myelopathy in Social Security disability determination.

Let me relate one final point that may seem minor to others but which I find fascinating. For more than a year before my fall, I had been complaining to my family doctor of coldness in my hands and feet. He had no idea why this was happening nor any solution for the problem. This coldness got much worse after the fall. By my hospitalization for surgery, it was difficult for nurses to draw blood or establish an IV line since the blood was hardly flowing to the skin of my arms. While I was in the recovery room after surgery I could feel the warm blood coming back into my feet. Soon after I got to my hospital room, I could feel warmth coming back to my hands. It fluctuates some but the blood circulation to my hands and feet has changed dramatically since the surgery. Getting a blood sample or establishing a new IV line became easy. I related this to the neurosurgeon. He did not seem surprised. He had already been told of the difficulty drawing blood and establishing IV lines. He figured that the blood circulation problem was a subtle sign of the spinal cord compression that existed even before my fall.