Question
Dear Dr. Hartman,
On May 18,2007 I was in a head on auto accident. I sustained a C1 fracture and displacement along with facial lacerations.
I have been using a Jefferson collar since the incident and have just been told as of 9/20 that there has been no healing. Does this immediately confirm the need for surgery?
Thank you so much for your time and opinion,
Leslie

Answer
Hi Leslie-
You make 3 Leslies I have known with sci... I've only known one without- coincidence?

yes, probably.  Anyway, thanks very much for your question- I'll give you as much information as I have but I should make very clear that I am NOT a doctor.  That being said, here are my opinions, etc, and please write in again if anything is unclear or you have more to ask.  Deal?

I believe the surgery option is generally what is next if the injury is unstable- ie ligaments are torn or damaged.  Much of the time injuries to the cord come along with serious forces that damage the structure around the cord as well.  To the best of my knowledge, the surgical therapies are mostly associated with holding the bones to heal correctly- this is the only way it is beneficial to the cord.

So, in more succinct words, whether or not surgery is necessary would depend on the stability at the level of injury.  Personally I'd get several opinions - such a high injury, if anything went wrong (either in surgery or because you didn't have surgery) it coud be very bad.  

Here is a link to an onine text book that I've found useful more than once- it might have some additional info for you:
http://www.wheelessonline.com/ortho/atlas_frx_jefferson_fracture

thanks again for writing- I wish you some good luck, it sounds like you've had plenty of the bad

leslie