Grand-national winning jockey in hospital with spinal damage

The former Grand National-winning jockey, Graham Lee, has suffered spinal cord damage following a fall at Newcastle Racecourse. The 47-year-old Irishman has been diagnosed with an unstable cervical fracture, and damage to blood vessels in the mid-cervical region. Peter Hamlyn is founder and president of the Brain and Spine Foundation and medical director at the youth sports injury charity, Podium Analytics…

Peter - The spine is made up of three important structures. There's the muscles, there's the bones that are supported and moved by those muscles. And then running through the centre of it is the spinal cord, which effectively is the motorway from the brain for the rest of the nerves in the body.

Will - And what happens in this kind of injury when it gets fractured?

Peter - These are injuries to the bony element of that structure. So the bones fracture, like you can fracture a leg, you can fracture a bone in your neck, and they are classified as either stable or unstable. So some fractures are profoundly unstable, some are essentially very stable and therefore inverted, safe to have, and the others are somewhere in between. Now if it's unstable, it means that the bones can then start to slide one on another, and the spinal cord is actually about the size of a finger. It's incredibly delicate and if the bones move, it can get torn or bruised.

Will - As we record this, we know that Graham Lee is in intensive care. What will his treatment have been like from the incident up to now and then into the future?

Peter - There are really three or four phases to the treatment. The first is to save the patient's life. If these are injuries that occur high in the spine above, say, the 4th cervical vertebra, you will have a significant impact on the patient's ability to breathe it. It will have divided the nerves that drive the chest and the diaphragm. So you are then into the business of needing a ventilator and the horse racing community got onto the need for that very early actually compared to other sports. You then evacuate the patient to the hospital. They go into intensive care and are supported to varying degrees with their breathing depending on how much trouble that mechanism is in. That's your first step really, the stabilising and life saving. Second phase is then about doing what we just talked about. How do you fix the spine in a bony sense? How do you make it strong again and stop further damage? Most often we're using operations to do that. And then the third phase is what we might call the recovery and rehabilitation. As yet, we do not have a method of inducing the central nervous system, the brain and the spinal cord to repair. And this is the problem that faces patients with all neurological disorders. The neurological disorders kill and they also disable more people than either cancer or heart disease put together. They're incredibly common. There are 11 million victims of neurological disorders and the one thing they all have in common, be they stroke victims, multiple sclerosis, Parkinson's, spinal cord injury, head injury, is that their nerves are damaged. And what we are looking for is the magic whereby we might be able to bring about a repair. At the moment, it's just letting nature take its course and they will have a good degree of insight into how he will do going forward because the MRI scans these days are able to give you very accurate information as to what the state of the spinal cord will be. So Graham will have had, at some point as soon as he's stable, an MRI scan to see what the spinal cord is like. But even those amazingly accurate scans only give you an approximation of the extent of the damage. We can't see inside the spinal cord to see what's going on. And so it's really just time to see how much recovery he gets and what legacy his injury will leave him with.

Will - In terms of purely sport, there's been a big push recently to take injuries like concussions more seriously. But do you think that now that we know what we know, there is a need to reassess how we protect the spines of our athletes as well?

Peter - I think there are two parts to that, really. The first is what happened in the individual on that day, in that particular incident. And everyone will be looking at what happened, what they did, if the accident could have been prevented, and if it was responded to as well as it possibly could have done. So it always brings with it a lot of soul searching internal inquiries. The second is, have we in general got the right regulations? Have we got the right provisions? And if you look at the history of sports medicine, it's all about collecting data. Who's injured, where, how, and when. Bringing in a measure to tackle what happened to that particular individual. You make a change. You then measure again, if you get another injury, you make another change and you carry on until you have really reduced the changes. Horse racing has actually been one of the leaders in that it has some high risk elements and some low risk elements. Graham was involved in flat racing, which traditionally is associated with many fewer injuries than say, jockeying or equestrian. We have some very exciting frontier work going on. There are some remarkable plastics which instantly become solid if you hit them so that you can wear them a bit like a wetsuit. But if they're subject to trauma, they will instantly become rigid. And whether we can start to get out some sports men and women in equipment made in these new remarkable materials and improve safety is something we're going to need to look at. Short answer to your question is there's always improvements that can be made. The horse racing community has been one in which driving change has been met with a very positive attitude. And so I'm sure they will be looking at things.