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Thread: C1/C2 Fracture, no spinal cord involvement

  1. #1

    Question C1/C2 Fracture, no spinal cord involvement

    Good Evening,

    Last week, my aunt had two falls - one at home and one at a hospital near her house. After an MRI at the hospital, they determined that she had fractured C1/C2 and she was transported to a level 1 trauma center. She doesn't have spinal cord involvement and I know that this is an SCI forum but I was hoping that I might be able to benefit from the wealth of information here on the forum.

    I met with the neurosurgeon, my aunt, and other members of my family last week to discuss treatment options. The neurosurgeon strongly recommended a halo but gave us the option of fusing C2/C3 due to ligament damage between the two. We all agreed (my aunt, family, myself) to do the fusion. My aunt is only 55 but she has rheumatoid arthritis and was preparing for a knee replacement so she's a bit shaky on her feet and we wanted to take a more proactive approach with this.

    Surgery went well and a screw was placed between C2/C3 on the anterior side and some donor bone was grafted onto the fractures on C1/C2 to help promote healing (I think I'm explaining this right). She was off the vent about 24 hours after surgery. However, when they took x-rays on Friday there was still too much movement in her spine so they made an adjustment to the halo.

    Today, the nurse called and said that the neurosurgeon wanted to meet with a family member to discuss the next plan of action. Even after the halo adjustment, there was still quite a bit of movement. His main concern was that bones that move aren't going to heal as readily and this is in the hospital...in the ICU...after an adjustment. His recommendation was to do a posterior fusion of C1 to C3. After showing us the CT scan of the supine and upright spine, it made the decision easy and so my aunt signed off on the consent. She'll go in for the fusion tomorrow morning.

    Although I'm just "the niece", I'm the information junkie in the family and so my aunt has asked me to be involved in all of the doctor consults. After speaking with the neurosurgeon today, I found out that the fractures are from an extension instead of a flexion and that there is ligament disruption between C2/C3 and a plate fracture and lamina fracture of C2 (I had no clue there were different types of fractures but there were several distinct fractures in C2). I can't read my writing (I was writing quickly) but I think that C1 is a posterior apical fracture...?

    Anyhow, I'm rambling and I apologize. I'm on information overload. My aunt's biggest fear is paralysis and so I'm trying to find resources on paralysis percentages after fusion/halo (aside from the risk of surgery). I am a college student so I have access to PubMed so if you know of a resource in a peer reviewed journal, I can look it up.

    If you've made it to the end of my rambling, thank you.

  2. #2
    Hi Mellie, Welcome to the forum. Sorry to hear about your aunt. She's very very fortunate not to have any paralysis, esp at C1/2.

    As far as I know, once the spine is stabilized, the perecentage of paralysis is really low. Barring any complications from the surgery. I think she may have some challenges with the fusions mostly in that they fused the vertebras.

    I'm sure the SCI nurses or others with more knowledge will be able to answer more clearly.

    I had my T6/7 fused after my accident 36 years ago. No problems with it since.

    Good luck, please keep us posted on her progress and know you and the family are in ours thoughts and good wishes. Patrick

  3. #3
    Hi Patrick,

    Thank you for your response. After spending a few days reading I also came to the conclusion that she's very lucky to not have any paralysis with her breaks. It is good to read about your recovery after your fusion.

    Warmly,

    Mellie

  4. #4
    I had fusion at c4-8 & haven't had any problems with it, except a little 'pop' now & then. Hope your Aunt is getting along well - speedy recovery!

  5. #5
    I have asked Dr. Young to review this thread and make any recommendations.

    She is extremely lucky to not have any neurologic deficits!

    (KLD)

  6. #6
    Quote Originally Posted by Mellie View Post
    Good Evening,

    Last week, my aunt had two falls - one at home and one at a hospital near her house. After an MRI at the hospital, they determined that she had fractured C1/C2 and she was transported to a level 1 trauma center. She doesn't have spinal cord involvement and I know that this is an SCI forum but I was hoping that I might be able to benefit from the wealth of information here on the forum.

    I met with the neurosurgeon, my aunt, and other members of my family last week to discuss treatment options. The neurosurgeon strongly recommended a halo but gave us the option of fusing C2/C3 due to ligament damage between the two. We all agreed (my aunt, family, myself) to do the fusion. My aunt is only 55 but she has rheumatoid arthritis and was preparing for a knee replacement so she's a bit shaky on her feet and we wanted to take a more proactive approach with this.

    Surgery went well and a screw was placed between C2/C3 on the anterior side and some donor bone was grafted onto the fractures on C1/C2 to help promote healing (I think I'm explaining this right). She was off the vent about 24 hours after surgery. However, when they took x-rays on Friday there was still too much movement in her spine so they made an adjustment to the halo.

    Today, the nurse called and said that the neurosurgeon wanted to meet with a family member to discuss the next plan of action. Even after the halo adjustment, there was still quite a bit of movement. His main concern was that bones that move aren't going to heal as readily and this is in the hospital...in the ICU...after an adjustment. His recommendation was to do a posterior fusion of C1 to C3. After showing us the CT scan of the supine and upright spine, it made the decision easy and so my aunt signed off on the consent. She'll go in for the fusion tomorrow morning.

    Although I'm just "the niece", I'm the information junkie in the family and so my aunt has asked me to be involved in all of the doctor consults. After speaking with the neurosurgeon today, I found out that the fractures are from an extension instead of a flexion and that there is ligament disruption between C2/C3 and a plate fracture and lamina fracture of C2 (I had no clue there were different types of fractures but there were several distinct fractures in C2). I can't read my writing (I was writing quickly) but I think that C1 is a posterior apical fracture...?

    Anyhow, I'm rambling and I apologize. I'm on information overload. My aunt's biggest fear is paralysis and so I'm trying to find resources on paralysis percentages after fusion/halo (aside from the risk of surgery). I am a college student so I have access to PubMed so if you know of a resource in a peer reviewed journal, I can look it up.

    If you've made it to the end of my rambling, thank you.
    Mellie,

    I give you an A for your description of what happened with your Aunt. Despite your calling it "rambling", it was succinct and accurate.

    Let me fill in a couple of pieces of information that you are probably unlikely to get from perusing the internet on the subject of C1/2 injuries. First, most people who are "unlucky" and get significant damage from a C1/2 fracture don't survive to talk about it. Therefore, almost all people who survive such an injury tend to have relatively little damage to the spinal cord. Most such people have significant room in their spinal canal and this is probably what saved them.

    Second, it is difficult to place hardware on the anterior side of C1 and C2. To do it properly, experienced neurosurgeons often go through the back of the mouth. The surgery is technically demanding and posterior fixation carries a risk of both vascular and neural injury. Your Aunt is still unstable because the screw was placed at C2/3 and not C1/2. The vertebral arteries run next the lateral pedicles of C1 and C2. Screws inserted posteriorly into these pedicles have about a 4.1% chance of damaging the vertebral artery but only a 0.1% chance of a neurological deficit (Source). So, neurosurgeons are nervous about this approach but the likelihood of a neurological deficit is low.

    Third, some time ago, I wrote an explanation of the ASIA classification system that included a description of C1 (Atlas) and C2 (Axis) vertebra (Source). Your aunt has what is called an atlanto-axial fracture (yes, I know... why Atlas became Atlanto, I don't know but that is the way it is (Source)). This may facilitate your search for information on the subject. If you do a search for complications associated with atlanto-axial fractures and posterior transarticular screw fixation, you will find what you want to know.

    Wise.
    Last edited by Wise Young; 12-08-2009 at 03:38 PM.

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