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Thread: C2 and C7 injury question

  1. #1

    C2 and C7 injury question

    Hello everyone! My boyfriend and I are new to CareCure Community, we are searching for some answers from people who are or have been in similair situations. Two weeks ago my boyfriend fractured his C7 racing dirt bikes in Germany, and 3 days ago we found out that he also fractured C2 breaking off a piece of the spine with a seperation of 2mm(not the spinal coard but the wing). The Doctors wanted to put him into a Halo or do surgery but they gave us a few days to decide, if he wears his neck brace 24/7. We are trying to find people who have fractured their C2 as well, and get feedback on what steps they took (halo/surgery/neck brace/natural medicine). We know plenty of people in the motocross industry who have had neck/spine injuries but have yet to find someone with this particular injury. We are torn as to what step to take as we want to make sure it's going to be what's best for his future and career. Any feedback or web-sites would be greatly appreciated.
    Thanks!

  2. #2
    C2 fractures are often managed with a halo, but with the combination of a C7 fracture as well, this would probably involve both a halo and a TLSO (body cast or brace). Surgical stabilization of C2 is technically difficult as any anterior stabilization would require an incision in the back of the throat and there is significant risk of damage to blood vessels to the brain, as well as the cord itself. It is impossible to give advice on the options without knowing a lot more about the degree of fracture (there are 3 "columns" of the spine that must be addressed when it comes to determining stability). I assume he does not have any spinal cord damage itself.

    Perhaps Dr. Young can comment.

    (KLD)

  3. #3
    To continue with a career racing dirt bikes after this type of injury?????seems crazy to me, but then I am just a mom...good luck to you with what ever decision you make...welcome to carecure - there are plenty of folks who can answer questions you might have

  4. #4
    Quote Originally Posted by MK57 View Post
    Hello everyone! My boyfriend and I are new to CareCure Community, we are searching for some answers from people who are or have been in similair situations. Two weeks ago my boyfriend fractured his C7 racing dirt bikes in Germany, and 3 days ago we found out that he also fractured C2 breaking off a piece of the spine with a seperation of 2mm(not the spinal coard but the wing). The Doctors wanted to put him into a Halo or do surgery but they gave us a few days to decide, if he wears his neck brace 24/7. We are trying to find people who have fractured their C2 as well, and get feedback on what steps they took (halo/surgery/neck brace/natural medicine). We know plenty of people in the motocross industry who have had neck/spine injuries but have yet to find someone with this particular injury. We are torn as to what step to take as we want to make sure it's going to be what's best for his future and career. Any feedback or web-sites would be greatly appreciated.
    Thanks!
    MK57,

    A short while ago, I posted some comments to a person who has an aunt (Source) with a C1/2 fracture (so-called atlanto-axial fracture) that did not cause spinal cord injury but also did not fuse and requires additional surgery. By coincidence there is another person (a 28-year old) who seems to have a C1/2 fracture but with spinal cord injury (Source).

    Let me add to the comments that I have made to both of these. Most cases of C1/2 injuries occur in people who happen to have a lot of room in their spinal canal and they usually survive with incomplete spinal cord injury. Rarely, a person with severe C1/2 injury will survive (such as Christopher Reeve) but this is because they are rapidly resuscitated. In the case of your boyfriend, he is lucky to have had a C2 and a C7 fracture without a devastating spinal cord injury.

    Germany has the best cervical spinal surgeons in the world. They invented much of the instrumentation used to stabilize the cervical spine. The fact that the doctors in Germany are giving the choice of a halo suggests that they don't think that the C2 and C7 fractures are unstable. This is because a halo is not all that effective for stabilizing a fracture site.

    The spine has three columns that holds weight (Source). One of the columns is the anterior column, composed of the anterior longitudinal ligament, the anterior (front) of the vertebral body, disc, and annulus. The second is the middle column, composed of posterior half of the vertebral body, disc, and posterior longitudinal ligament. The third is the posterior column, composed of facet joints (the lateral wings) and the ligamentum flavum, and other posterior elements.

    If you have a fracture of one column, the spine should be stable. If you have a fracture of two columns, particularly the anterior and middle columns, the spine is unstable. If you have a fracture of all three columns, the spine is very unstable and more than a halo would be required to stabilize. Your description of the C2 fracture involving only the lateral process on one side suggests that the C2 is stable. You don't describe the C7 fracture but I assume that it is also reasonably stable because the doctors are willing to let him go for a few days without a halo or surgery.

    Most surgeons are conservative and will recommend surgery if there is a likelihood that two columns are involved. I agree that it is better to err on the side of caution. Even if it is unlikely that that spine will dislocated further without some trauma, the person is vulnerable to catastrophic spinal cord injury with even slight trauma. The surgery to stabilize the spine is straightforward and not risky. The spinal cord will not be touched. If the anterior column is involved, the surgeon would go in through a small incision in the neck to the front of the spine, remove the disc and place bone to fuse if necessary, and put a titanium plate that usually span at least three segments, i.e. C6, C7, C8. If three columns are involved, it may be necessary to stabilize both the front and the back.

    There is one other advantage to surgery. It allows the person to go directly to rehabilitation within a week after the surgery and start the exercises necessary to keep the body in shape. If your boyfriend gets a halo, it probably needs to be kept on for at least 3 months. It will be a pain (literally, since the halo involves screws into the head), inconvenient, and interfere with exercise and rehabilitation. There is the risk that the fracture site will not heal, in which case surgery will be necessary. Finally, surgery would eliminate all risk of another cervical spinal injury until the fractures do heal.

    In summary, you should ask about the fractures. If they involve two columns, your boyfriend definitely should have surgical stabilization of his spine. If the fracture involve only one column, you do have a choice to go the halo or surgery route. If he has any neurological deficits or pain from the injury, I would suggest the surgery route even if the fractures involve just one column. It is safe and much better for his body to have the surgery than to go for several months on the halo. The surgery is safe.

    Wise.

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