First, I thought I'd explain just what a Jefferson Fracture is.
It is a 3 or 4 place fracture of the C1 vertebra. Simple as that!
Research I have done on this injury reveals that it is most usually suffered by males (of which I am not); it is usually a sports-related injury, occuring most often from diving and equestrian accidents.
You can easily visualize what happens, if you wish.
The C1 is different than all other vertebrae in that it is comprised of one solid ring of bone. The C1 acts as a washer of sorts between the skull and the C2 and rest of the spine. It is called the Atlas bone, for like the mythical figure of old, this Atlas holds the weight of the world (aka skull) upon its shoulders.
To say it is a pretty important part of the spine, I guess, would be an understatement. Its proximity to the skull base and cranial nerves means that movement of only millimeters can have a profound effect.
When a person lands with great velocity onto the very top of their head (as in diving into shallow water), the skull is pushed with great force unto the C1 ring. Something's gotta give! A Jefferson Fracture occurs when that C1 breaks in 3 or 4 places.
Our anatomy in this area is all held in place by ligaments, including the ever-important "Transverse Ligament." In a STABLE Jefferson Fracture, the burst fracture of the C1 springs apart, and the ligaments pull things right back into shape. This is still a serious situation, but the ligaments still being functional means that the fracture is stable and more conservative measures can be taken for treatment.
However, if the burst fractures go wide enough, this is indicative that the ligaments were all ruptured, broken ("ripped and torn" my neurosurgeon told me), stretched beyond compare and unable to pull the C1 back into position. In fact, radiologists are taught to recognize that a Jefferson fracture is unstable and the tranverse ligament is compromised by how far gapped the fractured sites are.
When this happens, an UNSTABLE Jefferson Fracture has occurred and the treatment for this is much more aggressive. Websites and doctors seem to vary a little bit about the course of treatment, but the "minimal standard of care" seems to be traction in the hospital for a week or so, then a halo being installed for the patient to wear for 3 months or longer. The point of all of this is obviously: stability while things are healing. This stability is of utmost importance.
The C2 is also in the picture, as the odontoid (or dens, a part of the C2) sticks up into the off-center of the C1. The odontoid is something of a bony finger or tooth and makes the C2 a unique vertebra, as well. The transverse ligament travels between the C1 and C2.
Tuesday, October 12, 2010
Tuesday, October 5, 2010
Once again we spend time at the ER. LOVELY
So they appt has come and gone. My numbing in my fingers got worse leading up to my appt. Over the weekend my pain increased substantially. So monday morning we call the doctors office to see what they would like me to do. The answer we got from the nurse on call was go directly to the ER. That this was a serious symptom that needed ot be addressed immediately. Off we go to the ER on the orders of the nurse. When we arrive there we WAIT and wait and wait. Now remember that I already had an appt in the clinic at 2:30pm. It is getting close to 100pm and still not even checked in yet. I guess when they say its serious they fail to let the people checking patients in that this is serious. Or they just don't know yet cause I still haven't even been seen by the triage nurse.
As we get closer to 230pm my wife went upstairs to check in the clinic to see if we should just come up there instead. So after sitting in the ER for several hours they say just come to your appt instead. WOW what a waste of the day. I guess there idea of emergency isn't the same as others.
Next we wait in the waiting room. Boy do I love waiting. Why do they tell you to be there at 230pm when they actually don't call you back till 250pm. Then they don't come in to see you till 305pm. why dont thye just be here at 300pm and we will see you within 5min. or your visit is free. Yeah that would work. HA that will never happen.
We finally get to see the doctor but (what you thought it would get better HAHA) We don't actually see the doctor. We get to see the resident instead of the attending. You know the guy in charge. The guy we get to see we have seen before but the first time didn't go so well. I don't think he even read my chart before he came in. Well maybe this time would be better.
SO we explain the numbing sensations and that we were told to go to the ER and he immediately says "Well we told you surgery was the best option from the beginning." Really, Jack ass that was never said to me. Then he says, " well once the vertebrae are past 7mm we always do surgery and yours are at 12mm." Really how can you tell me that, that was never said to me. "Well if you want your pain to go away surgery is what you need." Now I may be wrong a little on how he said it and exactly what he said. You get the point though. He was not very supportive of my original plan we went over and implemented with the attending and what it clearly said in my chart. Surgery is only a last resort. We will not do that until everything else fails. I want it to heal naturally so I can have full mobility.
As we are wrapping up the appointment he says "So do you feel good about the appointment." NO It was a waste of time. You answered nothing and made me feel horrible. You didn't even offer a solution as to why my hands and fingers go numb. Well I thing you need surgery he says. That will fix it. How can you recommend that without looking into it more. You have even said x-rays are not as detailed as you would like. Why don't we do something else to look into it further and better. Then he finally says we can do a scan of your neck. WOW It takes me asking you the resident to get something done. Maybe you should go back to lecture to learn how to speak with patients.
So we schedule a CT scan fo the following Monday.
Meanwhile his solution was wait and see how the scan goes but just wear the hard collar to help. All day everyday to support your neck it may not be stable thats why you go numb. SO the whole week I am stressed out about the results and worrying to no end. I didn't sleep well at all. I keep thinking I am going to have to have surgery cause its not healing and i feel like I am going backwards. The week was horrible.
Monday the 28th EW have another appointment to see the doctor to go over the results
Monday could not come quick enough for me. I finally should get some more informed answers. The scan was super fast, I didn't even have to wait in the waiting room. They were definatley on time. Next was the doctor. WOW they were on time too. Maybe this is a sign. Well one can wish right?
So who will we see today. If that other guy comes in I am going ot tell him to leave. I am glad when the attending walks in. He is so much better with patients and explaining whats going on with my neck. I am still nervous and really tense and cant relax. I do not want to hear the bad news if there is some. Thankfully everything checked out on the scan. It showed that my vertebrae are only 8mm overhanging not 12mm. So what does that mean to me. It means that I will not need surgery unless the pain becomes to unbearable to deal with on a daily basis. I will get full mobility back in my neck. Relief finally. I can feel it move throughout my whole body.
So what do I do now? Well that would be PT twice a week for awhile. I no longer need to wear the neck brace. The numbness is from inflamation that is in my neck from not moving. Not neurilogical signs that my vertebrae is moving. Of the four breaks of my vertebrae there is noticeable healing of three of them. The fourth may not heal fully but there is enough fibrous tissue in the other three to be called stable.
So now the next chapter starts today. I had my first appointment today at the Physical Therapy office at Harbourview Medical Center. This is where i will begin my journey back to where I was on June 22nd 2010. I have a great therapist and I will be back stronger than before. I just need to teach my neck to turn with moving my shoulders. I guess that is what happens typically to those with this type of injury. Your brain forgets that it is safe to just turn your neck. You have to get the neurons to fire again and show it that it will not injure yourself. I also shrug my shoulders up a lot. This is a reaction to my body trying to protect itself. Its crazy to hear I have to learn to turn my head again.
I would have never thought that I would be able to move this soon considering what my injury was. Well not moving freely yet, but I will.
As we get closer to 230pm my wife went upstairs to check in the clinic to see if we should just come up there instead. So after sitting in the ER for several hours they say just come to your appt instead. WOW what a waste of the day. I guess there idea of emergency isn't the same as others.
Next we wait in the waiting room. Boy do I love waiting. Why do they tell you to be there at 230pm when they actually don't call you back till 250pm. Then they don't come in to see you till 305pm. why dont thye just be here at 300pm and we will see you within 5min. or your visit is free. Yeah that would work. HA that will never happen.
We finally get to see the doctor but (what you thought it would get better HAHA) We don't actually see the doctor. We get to see the resident instead of the attending. You know the guy in charge. The guy we get to see we have seen before but the first time didn't go so well. I don't think he even read my chart before he came in. Well maybe this time would be better.
SO we explain the numbing sensations and that we were told to go to the ER and he immediately says "Well we told you surgery was the best option from the beginning." Really, Jack ass that was never said to me. Then he says, " well once the vertebrae are past 7mm we always do surgery and yours are at 12mm." Really how can you tell me that, that was never said to me. "Well if you want your pain to go away surgery is what you need." Now I may be wrong a little on how he said it and exactly what he said. You get the point though. He was not very supportive of my original plan we went over and implemented with the attending and what it clearly said in my chart. Surgery is only a last resort. We will not do that until everything else fails. I want it to heal naturally so I can have full mobility.
As we are wrapping up the appointment he says "So do you feel good about the appointment." NO It was a waste of time. You answered nothing and made me feel horrible. You didn't even offer a solution as to why my hands and fingers go numb. Well I thing you need surgery he says. That will fix it. How can you recommend that without looking into it more. You have even said x-rays are not as detailed as you would like. Why don't we do something else to look into it further and better. Then he finally says we can do a scan of your neck. WOW It takes me asking you the resident to get something done. Maybe you should go back to lecture to learn how to speak with patients.
So we schedule a CT scan fo the following Monday.
Meanwhile his solution was wait and see how the scan goes but just wear the hard collar to help. All day everyday to support your neck it may not be stable thats why you go numb. SO the whole week I am stressed out about the results and worrying to no end. I didn't sleep well at all. I keep thinking I am going to have to have surgery cause its not healing and i feel like I am going backwards. The week was horrible.
Monday the 28th EW have another appointment to see the doctor to go over the results
Monday could not come quick enough for me. I finally should get some more informed answers. The scan was super fast, I didn't even have to wait in the waiting room. They were definatley on time. Next was the doctor. WOW they were on time too. Maybe this is a sign. Well one can wish right?
So who will we see today. If that other guy comes in I am going ot tell him to leave. I am glad when the attending walks in. He is so much better with patients and explaining whats going on with my neck. I am still nervous and really tense and cant relax. I do not want to hear the bad news if there is some. Thankfully everything checked out on the scan. It showed that my vertebrae are only 8mm overhanging not 12mm. So what does that mean to me. It means that I will not need surgery unless the pain becomes to unbearable to deal with on a daily basis. I will get full mobility back in my neck. Relief finally. I can feel it move throughout my whole body.
So what do I do now? Well that would be PT twice a week for awhile. I no longer need to wear the neck brace. The numbness is from inflamation that is in my neck from not moving. Not neurilogical signs that my vertebrae is moving. Of the four breaks of my vertebrae there is noticeable healing of three of them. The fourth may not heal fully but there is enough fibrous tissue in the other three to be called stable.
So now the next chapter starts today. I had my first appointment today at the Physical Therapy office at Harbourview Medical Center. This is where i will begin my journey back to where I was on June 22nd 2010. I have a great therapist and I will be back stronger than before. I just need to teach my neck to turn with moving my shoulders. I guess that is what happens typically to those with this type of injury. Your brain forgets that it is safe to just turn your neck. You have to get the neurons to fire again and show it that it will not injure yourself. I also shrug my shoulders up a lot. This is a reaction to my body trying to protect itself. Its crazy to hear I have to learn to turn my head again.
I would have never thought that I would be able to move this soon considering what my injury was. Well not moving freely yet, but I will.
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