Question
my son was hit by a car last year in April. Among all his injuries he had surgery and now has a surgical screw holding his c1 and c2 together. After a year recent CT scans have shown that he is finally healing. My question is... he wishes to continue bike riding and riding a skateboard. What are the possible risks after this injury. We are still waiting for a consultation from the doctor however, this would clarify our arguments while we are awaiting our doctor visit.

Answer
Dear Jeanette,

This is a bit out of my area of expertise, due to the fact that I am not qualified to opine specifically on the strength of a surgical procedure...only a certified surgeon within that specialty (neurosurgery or an orthopedist with a spine fellowship) would be qualified.

However, if the CT shows that the surgical stabilization is fusing together appropriately, then the fusion site should actually be stronger than the the rest of the vertebral structure.  Surgery that fuses bone together creates an especially strong bond if there was a fracture causing the need surgical stabilization which has healed.  On the other hand, if the upper cervical ligaments of the spine were ruptured and that was the predominant cause requiring fusion of the C1 and C2 together, then residual instability is still and issue and I would not think the surgeon would want your son continuing skateboarding activity...or any aggressive bike-riding (BMX, freestyle, ramp, mountain bike or trail riding).  Regular bike riding on paved surfaces without "stunts" would probably be fine.

Bottom line here is that you really need to heed the advise of your surgeon on this one.  The C1/C2 area of the spine is a very sensitive and important area...you do not want another injury here...the fact that he could be stabilized with the initial surgery is great...many are paralyzed for life.  Caution is much better than the alternative.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net