C1 Jefferson Fracture

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  • bvs1
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    #26284 |

    I sustained a C1 Fracture (4 part burst fracture). After 2 months in hard collar, ct/mri showed non-union and transverse ligament was snapped of the type 2 dickman type. Doctor recommended surgery, however could only do a C2 to Occciput as I had stage 1 basiliar invagination from displacement. Surgeon indicated that this is a life altering surgery and the “end of the line” as far as spine surgery. After hearing the risks and life changes i decided against it. Scans after 6 month post accident showed that basiliar invagination had not progressed and stayed constant and obvious not union – but suspected that fibirious tissue had formed between the fractures.

    Surgeon had never heard of someone with this injury not getting surgery but at this point he felt that I was at no immediate risk for catastrophic failure. Flex/Extion xray where 4.5/5 respectively. He didn’t know any of his surgeon friends who had a patient like me either.

    I obviously have limitations now on neck movement and have pain.

    My Question – Can I live with this the rest of my life? Am I at risk for other problems done the line? How can I best stay on top of this? Even the surgeon said that he’d hate to do the c2-occiput on anyone as young as me(25)- and encouraged me to see if i can live like this. He said that he won’t do the C1-C2 because he’d hate me have to do another surgery should the dens of c2 progress down the road.

    Dr. Corenman
    Moderator
    Post count: 5543

    The question here is how sturdy is the fibrous tissue scar that currently holds the fractured edges of the C1 vertebra together? Since the transverse ligament is ruptured, this C1-2 stabilizing structure is gone as well as the capsules of C1-2. (see https://neckandback.com/conditions/stabilizing-ligaments-upper-cervical-spine-occiput-c2/ to understand the ligaments that lead to stability).

    The dens migrates superiorly due to the wedge-shaped facets of C1 being gapped apart due to the fracture separation allowing the dens of C2 to migrate superiorly (basilar invagination). What would have been useful is to have had a C1-2 fusion surgery where not only was C1 stabilized to C2 but the fracture separation reduced by mechanically pulling one side of C1 to the other using a crosslink. This would have pulled the dens out from its ascended position and realigned the occiput on top of C1 to allow continued useful flexion and extension through this 0-C1 joint.

    I am not sure if this realignment can be surgically performed now due to the scar formation but this still might be considered. I don’t think leaving this condition alone is safe as there is no way to test your neck stability and a fall might be catastrophic but might not. That is, you won’t know if you can live with this until you suffer a fall or blow that could cause significant damage.

    I no longer perform C1-2 fusions but if you want to call my office, I will give you the name of a surgeon that I trust to help you with this disorder.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
    If this forum has helped you, please let Dr. Corenman know!

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