Question
In short- My father fractured his C1 about a week ago swimmimg in the ocean. He is in bad shape from this but Thank God he is NOT paralysed and did not need surgery. Also (per his doctors) will not have to wear the Halo brace, but will wear another type of neck brace (less invasive than the halo) for 3-months. My question/concern is, could he still be in danger of paralysis? Also, if he jerks or moves the wrong way with just this type of brace will it be protective enough?

Answer
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Dear Abby,

C1 is a specialized vertebra, shaped like no other. It resembles a ring with a large diameter, and has two thickened areas on the side termed lateral masses, which articulate with the head above and the C2 vertebra below. The spinal cord passes within this ring.  A fracture of the C1 vertebra (also called a Jefferson fracture) will typically occur at the junction of the lateral masses from a load applied to the top of the head. This will break the C1 ring into two or four parts that will displace outwards (=away) from the spinal cord. Since to begin with, the diameter of C1 is large in relation to the spinal cord, the probability of neurological injury in these fractures is low.
A Jefferson fracture is usually treated non-surgically with good results. The type of brace used is at the treating physician's discretion, but rarely is a Halo brace needed. In elderly patients that have difficulties using cumbersome braces, I've used a simple Philadelphia-type collar with no complications.

I hope your father feels better,

Dr. Rahamimov