Polite Dissent

I hope it goes without saying that Batman’s recovery is nothing short of miraculous: in less than two years, he manages to go from struggling to breathe to a full return to crime fighting, none the worse for wear. As the late night infomercials say, “results not typical”.

For the purpose of this post, I’m going to focus on the period initially after the injury where he is under the care of first his faithful butler Alfred, and then neighborhood physician Dr. Shondra Kinsolver.

I. The Injury
To start off, let’s take a close look at what happened to the Dark Knight. There are two mechanisms of injury here. First, Batman’s spine is hyperextended; it’s bent backwards farther than any back is meant to go. Second, Bane is driving his knee into the back, pushing the spine forward.
[click here for an annotated image.]

II. The Doctor’s Assessment

Dr. Kinsolving: These x-rays clearly show a fulcrum-type stress fracture. Not at all the kind of trauma sustained in a car crash.

Dr Kinsolving is both right and wrong.

She’s right in that the way the injury was explained to her (a car accident) does not match the injury she observes (blow from behind). Alfred tries to explain it away, but she’s already suspicious.

However, she’s wrong in the way she herself describes the injury. While Bane’s knee was used as a fulcrum to break Batman’s back, what he suffers is not a fulcrum fracture per se. Those are a type of Chance fracture and occur with hyperflexion (the back bending forward too far), not hyperextension.

It’s not really a stress fracture either. Those can occur in the spine, usually with an increase in repetitive trauma (for instance, athletes who increase their workout), or with trauma. However, stress fractures of the spine don’t occur in the verterbral body, and do not occur with the kind of trauma Batman experienced.

Despite what she says, I don’t seem much of a fracture on the x-ray she’s holding up, unless it’s the diagonal line on the vertebra. If that’s what she’s referring to, it doesn’t match the type of injury she’s describing, or the one Batman suffered. [click here for an annotated image.]

(Based on the mechanism of injury, I’d predict that Batman suffered a fracture/dislocation injury. There was some spinal breakage occurring, but most of the injury is from one or more of the vertebrae being pushed forward into the spinal cord, injuring it).

III. Steroids
Steroids are a good treatment for spinal cord injuries. Bear in mind the term “steroid” generally refers to one of two related, but distinct, classes of medication.
1. There are the infamous anabolic steroids. These are the ones that cause an increase in muscle mass and have been abused in most major sports; Bane’s own drug Venom is a particularly fast acting and potent anabolic steroid.
2. Then there are the glucocorticoids (a type of corticosteroid). These are potent anti-inflammatory and immune suppressing drugs. They are used for asthma attacks, poison ivy, autoimmune diseases and other conditions where it is important to calm down inflammation or the immune system. This is the class of steroid that is used in treating spinal cord injuries; it reduces the swelling and improves the recovery.

Decadron was not developed for or “specifically made” for spinal cord injury. It has many medical uses and was around a long time before anyone thought to use it for spinal trauma.

Additionally, it is not a controlled substance and is easy to obtain with a prescription. We have a large supply in a drawer in our office. I suspect the writer is confusing it with an anabolic steroid — which is a controlled substance.