Former President George H.W. Bush faces physical therapy and limited mobility in the coming months after breaking a neck bone in a fall, but the 91-year-old patriarch was in good spirits and lucky he wasn’t more severely injured, said the Portland doctor overseeing his care Thursday.

Bush fractured his second cervical vertebra in a fall Wednesday at his home in Kennebunkport, but the injury has not affected the use of his limbs, according to a spokesman.

GEORGE H.W. BUSH GALLERY

Bush, at 91 the oldest living former president, never lost consciousness following the neck injury, said spokesman Jim McGrath. He remained in fair condition Thursday at Maine Medical Center in Portland. He was fitted for a brace to immobilize his head and neck and will begin physical therapy.

The fracture did not have any neurological effects, McGrath said.

Doctors plan to let the injury heal without surgery, he said. They do not believe there will be a prolonged recovery period at the Portland hospital, but the attending physician, Dr. William D’Angelo, said at a Maine Medical Center media briefing that it would typically be months before a person with this kind of injury could resume a normal range of activities.

D’Angelo said that breaking the second cervical vertebra is not an uncommon injury in older people. Studies have shown it is most common in older people who fall and in younger people involved in car crashes. The president’s injury did not affect his spinal column, which would have been more serious.

D’Angelo said he was with Bush and his wife, former first lady Barbara Bush, less than an hour before the Thursday afternoon news conference and both were in good spirits.

“His wife said it would take a lot more than this to knock his spirits down,” D’Angelo said, noting that the former World War II pilot was once shot down in the Pacific.

“He’s up and talking and out of bed,” D’Angelo said.

The second cervical vertebrae sits below the so-called Atlas vertebrae, which supports the skull. The second vertebrae is particularly important in giving the head a wide range of motion. Had the fracture been more serious or broken a different part of the bone, it could have caused neurological injuries, D’Angelo said.

Bush, who has a form of Parkinson’s disease and uses a motorized scooter or a wheelchair to get around, fell on Wednesday and was taken by first responders to Southern Maine Health Care in Biddeford, then transferred to Portland. D’Angelo said he did not know what steps emergency workers took to stabilize the president to prevent further injury but he said it appears they did an excellent job.

Asked whether the former president was in much pain, D’Angelo said, “He’s tough. He can take it.”

Parkinson’s disease can lead to less mobility and balance, which can contribute to falls, D’Angelo said. Asked whether he believes Bush will make a full recovery, D’Angelo said he hopes so. He said when a person in his 90s sustains an injury like this, mobility could be more difficult for three to four months.

D’Angelo is a surgeon with the Neuroscience Institute at Maine Medical Center, specializing in neurosurgery and spinal surgery, according to Maine Medical Center’s website. He is a graduate of Tufts University School of Medicine and did his internship and residency at University Hospital of Michigan. He has been with the hospital since 1984.

Responding to a request for an interview with Bush, McGrath said the 41st president has said that he no longer grants interviews.

Sherry Morrell of Skowhegan was in the hospital’s special care unit visiting her sister Wednesday when she saw the former president.

“They closed our waiting room door and we watched Barbara go by with a walker and (hospital workers) rolled him by on the stretcher,” she said. “It was good to see him.”

Bush has suffered other recent health setbacks.

He was hospitalized in Houston in December for about a week for shortness of breath. He spent Christmas 2012 in intensive care at the same Houston hospital for a bronchitis-related cough and other issues.

Bush, a Republican, served two terms as Ronald Reagan’s vice president before being elected president in 1988. After one term, highlighted by the success of the 1991 Gulf War in Kuwait, he lost to Democrat Bill Clinton amid voters’ concerns about the economy.

Bush, the father of former President George W. Bush, was a naval aviator in World War II. He also was a former U.S. ambassador to China and a CIA director.

He has skydived on at least three of his birthdays since leaving the White House. He celebrated his 90th birthday by making a tandem parachute jump near his Kennebunkport home. He celebrated a low-key 91st birthday with his family there.

During the winter, Bush and his wife live in Houston.

Another Bush son, former Florida Gov. Jeb Bush, is running for the Republican presidential nomination in 2016.

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