Health: Saved by a joyous break with the past

TO MOST people, a broken neck means certain death. As the most vulnerable part of the spine, it is also the most prone to injury. But for one woman, surgeons proposed breaking her neck - twice - as the only hope of saving her life.

The unique operation, never attempted before, carried a one in 10 chance of death on the operating table. There were huge complications, the surgery took more than twice as long as expected, and the patient almost bled to death. But, three months later, she is well, happy and looking forward to enjoying her old age.

Sue Leeming had spent most of her adult life forced to stare at the ground because of a neck deformity. She suffers from ankylosing spondylitis, an inflammation of the joints similar to arthritis, and the bones at the top of her spine had crumbled and fused. Over the years, under the force of gravity, her head had fallen forward until her chin was pressed into her chest.

Pictures taken at her wedding to Aidan, her second husband, in Gretna Green last year, show how she could only see the knees of the priest who married them and was unable to make eye contact with any of their guests. Although she has normal sight, she was almost as socially isolated as the blind.

Last May, she faced a chilling choice. Her deformity had grown so severe that the smallest blow, jolt or fall could have broken her neck and killed her. Her breathing was laboured and there was a serious risk she would choke to death. But surgery to straighten her neck had never been tried before, and was highly risky.

The operation involved breaking her neck in two places, straightening it, and then inserting steel poles to hold it in its new upright position. Mrs Leeming, 48, had no hesitation in choosing surgery. "I was going to choke to death anyway," she says. "The outcome would have been the same. I had every confidence in the surgeon."

Most people with a deformity as severe as Mrs Leeming's are told nothing can be done because the risks of surgery are too high. Steven Gill, consultant neurosurgeon at Frenchay Hospital, Bristol, agreed to attempt the operation because he recognised her options had run out. What he could not have foreseen were the complications, which meant that surgery expected to last eight hours took 19, as doctors fought to stem the bleeding that threatened her life.

The operation began at 8am, and the surgical team worked through the day and evening until 3am the following morning. "I came out once for a Mars Bar. When you're faced with a situation like that you just have to carry on," said Mr Gill. Mrs Leeming received over 50 units of blood, equivalent to 25 litres, and her husband, Aidan, was warned more than once that she might not pull through.

The procedure involved drilling into the back of her neck to break and realign the bent vertebrae. Mr Gill had to work within a 2mm margin of error, avoiding the vertebral artery that supplies the brain and the spinal cord. The smallest slip could have killed or paralysed her.

With her neck bent so severely, the surgery had to be carried out from the back, which is more dangerous than going in from the front. Lying on her stomach, her head was below the level of the operating table, and pressure built up in the veins until the blood vessels started "popping". Mr Gill said: "One of the major problems she faced was surviving this massive transfusion."

The results of the surgery can be seen tomorrow on Tomorrow's World (BBC1, Wednesday, 7.30pm). Three months on, Mrs Leeming is still learning how to walk again. After years looking at her feet, she finds it hard to balance with her head up, unable to see where her feet are. But she has no doubt about the benefits: "I am ecstatic. I can breathe properly, and when I go shopping I can see more than just the bottom shelves. For the first time, I can drink out of a wine glass without using a straw."

One of the perils of being forced to stare at the ground was that she had been liable to bump into anything at head height. At their home in Gosport, Hampshire, her husband, Aidan, had fitted the kitchen cupboards with musical chimes to warn her when the doors stood open. "The first thing he did when I came home was to throw the chimes in the bin. We felt we had been given our house back."

One effect of the surgery has been disorientating for her and disconcerting for her friends. For the first time for years she can look people in the eye. Her surgeon, Mr Gill, said: "The impact on her socially is hard to imagine. When she met people in the street, she could never see their faces. Now, when people meet her, they look away. They are not used to making eye contact and neither is she."

The operation has restored her to society. But while normal social interaction brings many pleasures, it can also be a strain, especially for one whose face has for so long been buried in her chest. While Sue Leeming has recovered well from the physical effects of the surgery, adjustment to the social effects may take longer.