The spine and the long bones in prolonged coma

Prolonged coma or the injury that caused prolonged coma have no direct effect on the bones of the body other than traumatic fractures which usually heal well. On the other hand, prolonged coma is usually accompanied by inactivity, which in turn causes multiple skeletal problems.

The first consequence of inactivity is prolonged bed rest. Under those circumstances the bones tend to decalcify (loss of calcium), resulting in osteoporosis. This condition weakens the bones to the point where excessively vigorous exercising of the limbs or improperly performed exercises can cause fractures. Occasionally, the weakening of the bones is such that a severe spasm of the muscles is sufficient to cause a fracture. In a patient who cannot communicate, these fractures may go undetected unless one is extremely vigilant.

The second consequence of inactivity is noted when patients are placed in a chair for long periods of time -- a common practice in hospitals and long term care facilities. A patient with poor muscular support for the spine will slouch over to one side after a short while in a chair, usually to the same side. The result is a scoliosis (abnormal curvature of the spine).

Osteoporosis can be avoided by judicious use of a tilt table.

Scoliosis can be avoided by allowing only short spells in a chair (15-30 minutes), with attendance during that time. If longer periods have to be spent in a chair, then a reclining chair is recommended, at 15-30 degree elevation from the horizontal position.

Mihai D. Dimancescu, M.D.
Director of International Coma Recovery Institute
Chairman, CRA

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