The South African cycling community was shocked yesterday at the news of Olympic contender Sifiso Nhlapo’s serious training accident in Norway. Nhlapo crashed, came down on his head, and fractured his third and fourth cervical vertebrae.
Nhlapo has been making headlines since 2005 when he was crowned the Junior Cruiser World Champion. In 2008 he was 2nd in the European BMX championships and 3rd in the Worlds.
Despite having to miss two events so far this year, Nhlapo had taken six straight wins to put him in 3rd position in the European championships. This wins have seen his rank go to #1 in Europe and #4 in the world.
In 2009, Sifiso “Skizo” Nhlapo was the only BMX rider to represent South Africa at the Beijing Olympics.
According to Health24’s Handicap Expert Dr Anrich Burger, when dealing with injury to the 3rd and 4th cervical vertebrae, the extent of the damage must be carefully assessed, and quickly. If the nerves remain intact, prognosis for a full recovery is good. Last night Nhlapo’s surgeons reported that no nerve damage is evident.
Dr Burger noted, however, that the recovery from such an injury is a delicate process, and Nhlapo is thus not out of the woods: even the pressure of a post-operative haematoma (bleeding, bruising) can cause subsequent damage to the nerves.
Not a simple fracture
There are many kinds of injuries that can occur in this type of accident. The most common is a compression fracture and a burst fracture, but parts of the vertebral bone can also break off. The small joints may dislocate. The injury will cause swelling of the soft tissue in the area and obviously pain, but if no nerves are injured Sifiso should not have any ongoing symptoms in the neck or below.
According to Burger, the injury Sifiso Nlapo sustained is severe, and uncertainty will remain as to his recovery for at least a period of 12 weeks.
Treatment of cervical fractures will depend on the severity of the injury. As in Sifiso's case, it seems that he has a complex fracture that requires surgical repair and spinal fusion. This can result in a long recuperation time followed by physical therapy.
Burger points out that there are however, risks involved with a cervical surgery, and should any of these complications occur, it will affect his recuperation time, as well as his bodily functions.
Potential complications include injury to the spinal cord and nerves.
With an anterior fusion, damage can occur to the esophagus, vocal cords, carotid artery.
Long term complications can include
- non-healing of the bone graft site
- secondary infections
- failure to improve
- pain in the bone graft site
- instrument breakage can occur (pins & plates used to stabilise the fracture)
The patient can also be paralysed during the operation or afterwards, should infection occur or pressure form on the spinal cord, due to the formation of blood clots in the spinal cord area or excessive soft tissue swelling, said Burger.
Road to recovery
According to Burger, Sifiso's functional impairment will depend on the outcome of his operation and possible complications. If everything goes well, and a good fusion and stabilisation of the cervical fracture is accomplished, he will need strict bed rest for a couple of weeks. He will also have to wear a rigid collar for at least 8 to 12 weeks. Physical therapy in this recovery time will be beneficial. Being a young fit athlete will speed up his recovery time, and should leave him without any physical limitations.
While there is no sign of paralysis, and the prognosis is positive, Nhlapo will be nevertheless be in a brace for up to six weeks, and out of action for the rest of the season.
BMX star injured in crash
(Niels Colesky and Joanne Hart, Health24, June 2009)