THE SPINAL CALL

Moscas En La Casa

It was about 7 pm when we arrived the emergency room for our night shift. Honestly, it seemed like a very uneventful shift. Besides the occasional buzzing from the flies that apparently seemed very interested in my sandwich, and my friends/classmates arguing about the recent Big Brother Nigeria eviction.

I would intermittently join in but my priority was my sandwich, obviously.

By 9 pm, we had already all concluded that it was going to be a happy call with no emergency, but we had spoken too soon, because apparently, the night is dark and full of terrors!

The Patient

BY 9:05 pm, we heard the unmistakeable blaring of the hospital ambulance.

I know what you're thinking. You think I went on lifesaver mode, dropped my sandwich and ran out yeah?
But nahhh. See, not because I'm an undetached heartless human but because in the teaching hospital, we don't often get life-threatening emergencies and in the times that we do, there are no stretchers, no ventilators and none of that highly sophisticated equipment you see on Grey's Anatomy. And if you are from around here, you would know that blaring siren are the exclusive preserves of politicians and well, dead people.

Well, it turned out that we were wrong. We got a life one. I took the history of the patient. He was a 29-year-old. Let's call him Zee.

Assessing the Patient

Zee was married with three kids.
At about 3 pm, he was driving his motorcycle to see his sister who had just put to bed. He was so excited about being an uncle that he had forgotten to put on his helmet. On his way, he was hit by a cement-carrying truck that came with full speed out of a T-junction. He somersaulted a couple of times and then landed on his back by the roadside. Once he landed, he was unable to move his lower limbs(legs) and could only partially move his upper arms (hands). Also, he urinated and defecated on himself.

A cervical(neck) MRI showed an almost complete transection of the spinal cord at C5.

Now, let us talk about all that gibberish.

The Spinal Cord

The spinal cord is a delicate bundle of nerves that carries messages between the brain and the rest of the body.

^{Figure 1: Image Created by the Author}

In this delicate bundle are motor nerves descending from the brain(nerves that help you move muscles) and sensory nerves ascending to the brain(nerves that help you feel things)

It is located in the vertebral canal/vertebral column/spine which consists of 33 small bones(vertebrae). They include:

• 7 Cervical (neck)

• 12 Thoracic (upper back)

• 5 Lumbar (lower back)

• 5 Sacral (sacrum--located within the pelvis)

• 4 Coccygeal (coccyx--located within the pelvis)

By adulthood, the five sacral vertebrae fuse to form one bone, and the four coccygeal vertebrae fuse to form one bone.

These vertebrae function to stabilise the spine and protect the spinal cord.

This vertebral column serves to protect the spinal cord from injury.

^{Figure 2: Parts of the Vertebral Column Which Houses and Protects the Spinal Cord}

Spinal cord injury (SCI) can be caused by a varied number of ways, all of them equally traumatic. When it results in a bruise of the spinal cord, it is called a Contusion. It could also be a partial tear or a complete tear in which case; it is called a Transection in the spinal cord.

Types of Spinal Cord Injury (SCI)

Spinal Cord Injury are of two types depending on the level of damage of the spinal cord:

• Complete Injury: When there is a complete injury to the spinal cord, there is neither sensation nor movement in the parts of the body that is below the level of the injury. The whole body (left and right) from the level of damage downwards is entire without mechanical or sensory function.

• Incomplete injury: Incomplete injury can happen at any level in the spinal cord. A spinal cord injuty is said to be -Incomplete when the damage is such that there is some function left in the body parts below the point of injury. In most cases, there is more function and sensation on one side of the body more than the other side.

)
Cervical MRI Showing a Teardrop Fracture

Once a segment of the spinal cord is injured, the functions served by the spinal nerves below the level of injury are lost.
Thus, the higher the injury, the bigger the complications.
For example, the dominant control of respiration is C4, so an injury above C4 will lead to cessation of breathing.

Understanding Zee's Problem

As I said earlier,

A cervical(neck) MRI showed an almost complete transection of the spinal cord at C5.

What this implies was that Zee would lose the ability to perform all actions mediated by nerves beneath C5 such as

• elbow, wrist, finger, knee and leg movement.
• bladder control
• defecation control
• achieving an erection

The medical officer on call has told Zee's family that things don't look too great for him.

Now, I'm a trainee-doctor, so I understand that there is very little or no chance of Zee ever walking again, or carrying his new nephew or even making love...but his friends and family do not understand this. His 3-year-old daughter keeps crying to be carried by her dad.

They've been holding hands and praying for the past 3 hours, some of the nurses on call have even joined in the prayers.

Zee has developed a fever, so I have to give him an IM paracetamol injection. I ask for his consent, and he says "Oh, go ahead, I won't feel it anyway."
I went ahead and just as I'm about to leave, Zee musters the power he can from his weak hands to grab my lab coat and failed. I stopped and looked down, and with tears in his eyes he asks

"Doctor, I'll be alright, right? This can't be the end of my legs right?"

Tears started welling up in my own eyes. I couldn't bring myself to be the one to dash his hopes with the knowledge I think I have. I also didn't want to raise his hopes falsely.

I blinked severally to send back the tears, and I said:

"If you believe in something bigger than the physical, now would be the time to hold on tight," then I reluctantly walked away, realising that while knowledge is power, the more you know, sometimes, the sadder you become.

Thanks for reading!

❤❤❤

Written by @the.chiomz

---

References

1. Health Library | Anatomy of the spine
2. Wikipedia | Spinal Cord Injury
3. Medscape | Anatomy of the Spinal cord
4. MRI
5. Wikipedia | Motor Nerves