Hello doctor, A friend of mine, who was in his 80's, had a fall in his garden and as a consequence fractured his neck and died from transection of the cervical spinal cord. I will explain what happened.He was in his garden, on a cold winters day, standing in a ditch, that was not deep or wide when he tripped over something and fell backward onto his back. The surface he landed on was not hard. He was lying in the ditch and could not get up despite trying. I found him lying in the ditch for one and half an hour after the fall. He was trying to get up out of the ditch, and he could raise his head off the floor and his upper body slightly but not pull himself upright and out of the ditch. He wanted me to pull him up and out of the ditch. First of all, I assessed what injuries he thought he had, he had no pain in his head, neck or back, but thought he had broken his arm after smashing it against the side of the ditch as he landed. I decided not to pull him up in case he had any other injuries, so I phoned for the ambulance. While waiting for the ambulance to arrive, my friend said he had a strange tingling sensation in his legs. A paramedic arrived first before the ambulance, and he assessed my friend for any injuries. The paramedic then decided to get my friend out of the ditch, and as he was trying to get him out of the ditch, my friend said he could not feel his legs despite being to move them. The paramedic eventually got my friend out of the ditch and sat him down on a seat. The ambulance arrived, and instead of escorting my friend into the ambulance on a stretcher, the paramedic walked my friend into the ambulance. My friend walked from his back garden, down some small steps, and a sloping drive into the ambulance, covering a distance of about 40 meters. His arm was in a sling, and he was walking at a steady pace, but from what I saw, the balance was normal. It was when he was taken to the hospital that he was diagnosed with a fractured neck and died a few days later from transection of the cervical spinal cord. There was an inquest into his death, which I could not attend, where there was a verdict of accidental death. There are some questions I would like to ask about his injuries, please. He had no close family, so I can not ask them, and the coroners service can not give me any information because I am not related to him, and it is confidential information.So I would appreciate it if you could answer these questions, and I would particularly I like to know if there was any more I could have done to help him. The questions are, (1.) Did the fall cause the transection of the spinal cord the moment he fell and fractured his neck? (2.) If that was the situation would he have not survived even if I found him straight after his fall, and not 1 to 1 1/2 hours later, and also if he was kept immobilized and not walked after the fall would it be the case he would not have survived. (3.) Or would the fall have not caused the transaction of the spinal cord the moment he fractured his neck, and it was the period after the fall when lying in the ditch and moving around trying to get himself up that may be an unstable, broken bone in his neck struck his spinal cord and severed it? (4.) Or would the fall have only caused a slight spinal cord injury and if I found quicker and he was kept immobilized he could have survived? (5.) While waiting for the ambulance to arrive my friend said he had a strange tingling sensation in his legs and also when the paramedic was trying to get him out of the ditch, my friend said he could not feel his legs despite being able to move them, were the signs he had a spinal cord injury at that time? (6.) If my friend had severe injury his spinal cord when he fell or the time afterward, how could he have managed to walk into the ambulance 2 to 2 1/2 hours after the fall? (7.) Would it have been the walking that caused the most damage to his spinal cord? (8.) Can a person with a severed or partially injured severed spinal cord walk?
Hello,  Welcome to icliniq.com. 1. Yes, the fall seems to be the cause of the fractured neck and the damage to his spinal cord (attachment removed to protect patient identity). 2. Nothing would have changed if you found him one or two hours before. 3. I think that the fall caused the vertebral column fracture. Then, during transport to the hospital, the instability of the vertebral column has to lead to compression of the spinal cord, probably due to a wrong posture. 4. As he had tingling in his legs and could not feel them, these are signs of a spinal cord injury, probably in the posterior part where the sensory columns lay. A person with partial spinal cord damage can walk if the motor pathways in the anterior spinal cord are not damaged. But there is no way to know if he had broken his neck because he had no neck pain. So, it seems that this was a fatal injury. He should not have walked, but even if this did not happen, I am not sure if he could survive. You should know that the most important thing after a spinal cord injury is the swelling of the spinal cord, which increases in size in the next days. That is why his situation worsened the following days. You should know that the respiratory heart nerve pathways and lay on the cervical spinal cord. So, probably as the spinal cord has been swelling in the next days, it has affected this area, causing his death. There is no way to predict that if something changed in the management of the situation, it would make him live. This is because cervical spinal cord injuries have a high mortality rate and poor outcome. I hope you will find this information helpful. If you have any other questions, please do not hesitate to ask me again.