My accident and the lessons I learned
I am a man in my 50s and have been living with AS since my teens. I was diagnosed at the age of 20. For the last 20 years or so my condition has been largely inactive and I have managed it with exercise which has mostly kept the pain away. It has left me with a stiff spine however, I have some rotational movement in the spine but bending is a challenge. I have not been under the care of a rheumatologist for many years, I was signed off a long time ago as my condition was stable and my levels of inflammation were low.
Generally I am fit, healthy and active. I enjoy activities such as walking, cycling, sport, gardening and DIY. In March 2022 I was outside at home, repairing a flat roof that had been partly damaged by a recent storm. This involved working up a step ladder. To be honest, I was doing something that was not safe. I was too far up the ladder which was not secured at the bottom, and I was moving my weight around. The ladder slipped away from what it was leaning against, and I came down from a height of over a metre, landing on my two feet with straight legs. I then fell backwards onto a hard surface, landing flat on my back. The back of my head contacted with the floor, which was unusual due to the stiffness of my spine.
The pain was excruciating. I lay there for a short while, wondering what I had done. After a few minutes I decided to get up and walk into the house. I remember not being able to hold my head up. I took some strong pain killers and went to bed.
The next day I went with my wife to a local minor injuries clinic and was given codeine to help with the pain. When I got home I went to bed which made things worse. The pain was so bad I could hardly get out of bed so we called 999. The ambulance crew checked me over, decided nothing was broken, and sorted me out with some diazepam to further help with the pain. The day after, I went to see my GP who also checked me over, decided NOT to send me for an X-ray, and gave me anti-inflammatories for the pain. I was advised to get some physio should things not settle down in a few days.
The short summary of the next two months is that I spent much of my time lying down due to shoulder pain. I did see two different physiotherapists, neither of whom thought I had broken anything. Physio did seem to help with pain. I had several further visits and discussion with my GP surgery, who eventually sent me for a back and shoulder X-ray in late April (not neck). This did not show anything that explained the pain I was still having in my shoulders. It did show a moderate compression fracture of vertebra T10, of “indeterminate age”. Over this period I was also losing weight quite rapidly. In hindsight this was muscle that was wasting away due to lack of activity.
Eventually, I got fed up with being unable to sit or stand for more than a few minutes, and being unable to leave the house. I lost many things – my ability to be a husband and father, my social life, my normal active pastimes. I used my medical insurance to make an appointment with a private orthopaedic surgeon. My wife took me there on 6 May, he immediately took an X-ray of my neck.
I will never forget what happened when I arrived back at his office. The look on his face was very concerning – he said, “I can’t believe you have walked in here”. He told me my neck was broken at C6 and C7, and had partially healed but in a bad way. It would need a complex operation to fix it, the type of thing that can best be done by the surgeons at St. Georges Hospital in London.
I was admitted to a local hospital and then transferred by ambulance to St Georges overnight. On May 10 I was taken to surgery and had a plate and bone graft inserted from the front of my next to fix C6 and C7 and improve posture. The surgeons also fitted rods and screws at the back, down both sides of my spine from C3 to T3. This was due to the level of damage they found when operating – this included some “opening up” of C3 to C5 which I believe was due to the physio treatment given.
I left St Georges on 13 May, and the worst few weeks of my life then followed. Unknown to me, I had a serious bacterial infection in one wound, close to my spinal cord. I became increasingly confused and paranoid, and could not sleep at all. On 3 June while on the way to Scotland my infected wound burst and I ended up in hospital in Hull where fortunately there is a centre for spinal surgery. This was when things actually started to get better. They fixed me up and after a few days I was taken back to St Georges. I spent three more weeks there while they got the infection under control, and went home on 23 June to start my recovery (again).
In short, I have spent the last 3.5 years putting myself back together mentally and physically, with help from some medical professionals, my family, and my friends. The mental recovery was quicker than the physical one. Physically, I was in a deeply deconditioned state and had lost all strength and stamina. Since then I have gained over two stone in weight, by replacing the muscle mass I lost while lying on my back for two months. I am as fit and strong as I was pre-accident, perhaps even better. My outlook on life has changed – I am 100% focussed on enjoying life as much as possible. Work has become a low priority.
My story is not a good one. In hindsight I was seriously let down by my local GP surgery who did not send me for an X-ray. I did not have symptoms of spinal cord injury, but my medical history was very clear and I explained my AS history to ALL of the medical professionals that I came into contact with after the fall. The experts in St Georges were the only ones who understood how my injuries could have been so serious from what was only a minor fall. They referred to my spinal fractures as “chalk stick” – analogous to how a stick of chalk breaks when dropped onto a hard surface. My shoulder pain and weight (muscle) loss was also typical of a broken neck.
When I was diagnosed with AS many decades ago I remember being told to avoid contact sports – but not why. Now I know why – impact events and a stiff spine can be a bad combination. Had I known this, I would have acted differently in the past and taken more care to avoid falls and similar mishaps.
My main learning – hopefully of value to other sufferers of AS – is to absolutely insist on a proper investigation (= X-ray) after an impact event like mine. Medical history (= AS) is the overriding factor, not symptoms.
Happily, even after 3.5 years I am still improving physically and can do everything I did before my fall. I now have a more optimistic and relaxed outlook on life, and try hard to find the positive aspects of any situation or event. The whole experience in 2022 was horrendous, in particular the post-operative infection. I have left out some of the most gory and unpleasant parts of the story