Cervical vertebrae

C1 and C2 Spinal Cord Injuries

The spinal cord is an enormously complex structure that helps transmit nerve impulses from the brain to the rest the of body, controlling movement and body functions. There are 33 different segments of bone or vertebrae that protect the spinal cord and these are named according to their position.

The C1 to C4 (or cervical) vertebrae are located in the neck area. Below this are the thoracic vertebrae, next the lumbar and at the bottom the sacral vertebrae. Each section has nerves flowing out of them to various parts of the body.

Spinal Cord Injury Levels

Anatomy of the Spine
Anatomy of the human Spine

Injury to any part of the spinal cord can cause major problems with loss of mobility and sensation. Generally, the level of the spinal cord injury will play a significant role in the prognosis of the individual and, the higher up the damage, the more likely there are to be life-changing consequences.

Complete severing of the spinal cord will lead to loss of movement and feeling below the level of the damage. In the case of the highest vertebrae, C1 and C2, this can mean almost complete paralysis.

Compared to other types of spinal cord injury, damage in this area has the highest potential to cause a fatality.

C1 and C2 Spinal Cord Injuries

There are seven vertebrae in the neck area of the human body and C1 and C2 are the highest. They are also important as they do most of the work in supporting our heavy skulls.

C1 is also called ‘Atlas’, named after the titan from Greek mythology who was said to carry the whole world on his shoulders. The C2 vertebrae is also known as the ‘Axis’ and it is integral to the range of motion of the neck. Together they enable our head to move, nod and turn from side to side.

The good news is that a C1 or C2 spinal injury is fairly rare, even though the consequences can be extremely challenging to deal with for both the individual and medical professionals. Much depends on whether the damage is incomplete or complete.

In the case of a complete injury, the individual will almost certainly be faced with total paralysis. With an incomplete injury, there may be some motor function and sensation but also many issues to overcome.

Whilst someone with a complete C1 spinal injury is likely to have more challenges than a person with a C2 spinal injury, both will be life-changing and difficult to manage.

Symptoms will often include:

  • Complete loss of sensation below the area of damage.
  • Complete paralysis below the level of the neck with limited neck or head movement.
  • Having difficulty breathing without the help of a ventilator.
  • Being unable to speak properly or not at all.
  • An inability to control continence.
  • Muscle atrophy because of lack of movement

According to statistics, the most common cause of injury to this area of the spine is diving. This is followed by car accidents if there is an impact on the head. C1 and C2 spinal cord injury outlook in the case of a complete break is poor because communication is cut off from the rest of the body. 

C1 and C2 Spinal Cord Injury Management

While the resulting damage from a C1 or C2 spinal injury is severe and highly challenging there are protocols that can help manage the situation. The first important factor is to immobilize the neck when a C1 or C2 fracture is suspected. This is to help make sure no further damage is done.

In all cases, the head will be kept immobile for some months after the injury through the use of a medical equipment such as a halo vest which can prevent further damage from occurring.

The damage caused already cannot be reversed although surgical treatment for C1-C2, such as fusing the affected vertebrae together to reduce movement, can again help prevent further injury. If pain persists after the recovery period, surgical procedures such as a laminectomy have been shown to reduce symptoms.

Where the injury is partial, there may be rehabilitation and other treatments that can help the individual manage their condition and gain more movement. Nonsurgical treatment for C1-C2 injuries will also include learning to use assistive technologies such as power wheelchairs.

In many cases where the damage to the spinal cord is complete, an individual will likely require 24-hour care and help with daily tasks such as feeding and going to the toilet. They may also require medication to help with pain management and physical therapy to prevent the atrophy of muscles.

Most Serious Type of Spinal Cord Injury

C1 and C2 spinal injuries are typically the most severe because of where they occur. For a complete injury, motion and sensation below the neck will be cut off causing complete paralysis. Management is largely non-surgical and involves finding solutions to help the individual cope with daily living.