I wanted to write a bit more on fractures, specifically upper cervical because of Grandma. She is, by the way, doing much better and has been moved from Seattle to our local area and is currently rehabbing (is that a word?) at a nursing home. She was able to play the guitar a little the other day and is able to partially dress herself, so things are moving along. Thanks for wondering.

  She had a C1-C3 posterior fusion, because of stability concerns and because she had broken off the pedicle of C2 so therefore the possibility of shift and movement was too great without surgical intervention. She is able to move everything, and walk some and has good fine motor dexterity distally, hence her Bon Jovi imitation. No, she has always been a guitar player so this is great rehab for her.

  But I wanted to review the stability a bit more. I had initially written quite a piece on that, and lost it somehow in cyberspace. So the one I did enter was not the best. The C1-C2 area is the most mobile of the cervical spine. The bottom part of the skull, or the occipital condoyles, rests on C1,s lateral masses. This allows for most of the flexion and extension of the head as the condoyles articulate on the top of the body of C1. C1 has no vertebral body as we picture them farther down the spine,but it is connected with C2 with the pedicle, AKA odontoid. Most of the lateral rotation of the neck occurs at the C1-C2 junction. The mobility here is high, and stability of that area is mostly supported by ligament structures.

  I think I mentioned that C1 is a closed ring and that fractures result in disruption of this structure. The pieces do not have to be out of place to disrupt the inherent stability. The strength of the ligament structures can pull these pieces out of place and can result in weight displacement that is uneven. Now in someone Grandma's age, or those with curvatures of the spine close to the area, normal alignment can be altered and injury can be atypical. Just an added bonus for those trying to repair the problem.

  Grandma had a burst fracture of C1, meaning the pieces stayed in place. My orthopod described my L1 burst fracture a few years ago as very much like when you are cooking a hamburger and you press down on the meat, sort of squishing it but that all the pieces stay in place. The main structure is the same, but there are fractures in the integrity of the original mass. And we all know that fractures weaken. A Jefferson fracture they called Grandma's. Forgive me if there is repetition here, but diving accidents are the main cause of these fractures. The can also occur in motor vehicle accidents if you are thrown against the roof of the car, I may have originally said dashboard...regardless, the forces are distributed to the body through the neck.

  Stabilization is the key to prevent further neurological damage. Edema will certainly be present in the area, and like any other injury site, that will initially impair function on varying levels, differs with each injury. This edema will go down, back to baseline in 6-12 weeks. But the edema itself can effect function, depending of course, on severity and particularity of the injury. Depending on severity of injury, there can be complete spinal cord injury necessitating intubation and eventually tracheostomy to support respirations. Severe injury can leave the person with only sensation to the face and motor control of the facial muscles from cranial nerves.

  This I can say...Grandma was damned lucky. Whether God was on her side, as I suspect may be the case, or she was lucky, who knows? But her guitar playing days are not yet over. Bon Jovi has nothing on her.