Matt Wetschler was bodysurfing at Ocean Beach in San Francisco when he went for a wave and didn’t come back up. Some other surfers saw his body floating like a log and pulled him ashore.
He was lucky: an ICU nurse happened to be walking along the beach and started CPR. By the time the ambulance arrived and shocked him, he had a heartbeat again. But his injury was serious — he’d fractured two vertebrae in his neck from hyperextension.
Wetschler was rushed to Zuckerberg San Francisco General Hospital and Trauma Unit (ZSFG), where he became the first patient to undergo an innovative new protocol for treating severe spine injuries.
“For many, many years, these injuries were believed to be irreversible, that if the spinal cord was injured, it was not coming back. We’ve been able to disprove that notion,” said Sanjay Dhall, M.D., a UC San Francisco associate professor of Neurological Surgery and director of Spinal Neurotrauma at ZSFG.
The new protocol, based on research by Dhall and others, is a mixture of revised evaluations and new treatments to personalize care that, in Wetschler’s case and others, spurred quicker recoveries.
This key part of the protocol stemmed from a surprising finding. A few years ago, Dhall enrolled some spinal injury patients in a Canadian study that looked at patients’ blood pressure in the spine — called spinal cord perfusion. The spinal cord regulates blood pressure in the body, so if it’s injured, the body may not be able to maintain adequate blood pressure.
“Traditionally what we’ve done is artificially raise everybody’s blood pressure exactly the same way, whether they’re 25 or 65, whether they’re young and healthy, or older and have heart problems or other issues,” says Dhall.
But in this study researchers actually measured each individual patient’s blood flow to the spine. Then doctors only artificially boosted blood pressure as needed to reach an individual’s unique resting pressure.
When a spinal injury patient enters a hospital, one of the first needs is to evaluate the extent of the injury.
Up until recently, the main way to evaluate a spinal cord injury was using physical tests that measure a patient’s ability to feel and move their arms and legs. This isn’t always a very accurate indicator, especially immediately after an injury.
“Very often, spinal injury patients have other injuries, they may have broken arms or legs, they may have a head injury, they may be unconscious — there’s several reasons why it can be hard to get a good exam on patients,” Dhall said.
Part of the new protocol that Dhall created is based on a recent study that found the most important factor in a patient’s recovery is actually related to blood pressure in the spine.