Day 37 Update - Let's Talk About Neck Bones

If you want a career with a nice predictable schedule that never changes, neurosurgery might not be for you.

My first post-op appointment with Dr. Lynn was originally scheduled for September 29th, but a couple days prior I received a call from his office that unfortunately the appointment would have to be moved a whole week and a half later to October 8th. This was, at first, disheartening - this first post-op appointment would include x-rays to ensure all the bones in my neck were still aligned properly and we were on the right track, and I was anxious to get that (hopefully) good news report. Then, the day before the October 8th appointment, I got ANOTHER call that Dr. Lynn had been called into an emergency surgery the morning of my appointment but that I should still come in and see his PA who I’d met at some point during my hospital stay. While unfortunate to not get to see Dr. Lynn himself, I realize this sort of thing must happen somewhat regularly. Whose regular appointment did I bump when I had to have my Halo procedure? Must be a constant scheduling nightmare, since it’s not like emergency spinal surgeries and procedures happen on a nice predictable schedule, after all.

The appointment with the PA was great. After a month of parsing the written (no visual) reports from several of my initial CT scans at the time of the accident, combined with a hefty amount of research on the cervical spine by way of Google and free-access medical journals, I finally came to a full understanding of exactly how the bones in my neck had broken. For those of you who are not, as of yet, experts on the cervical spine, please sit back and enjoy

BREAKNECK BEAN’S HIGHLY SCIENTIFIC LECTURE ON THE NECK BONE AREA

Okay, so, you have 7 vertebrae in your cervical spine, labeled C1-C7, that connect your skull to the top of your thoracic spine (your “back” spine, as opposed to the “neck” spine)

C1 and C2 - where the worst of my damage was located - are at the top, and they are a little different from all the rest - they have a unique mechanism that controls the rotation of your head from left to right. C1, at the very top, is “The Donut”. No kidding, that’s not my term, Dr. Lynn used that at one point describing things to me in the hospital, so that’s as scientifically accurate as it gets. C1 is a circular ring (hence, donut) that sits right beneath your skull - in fact your skull actually sits on two little “pad” areas right on the top. C2 sits right beneath it, and it is also semi-ring-like in shape, but with a really unique feature - a “Pin” that extends upwards from C2 into the ring of C1. The Donut rotates around this Pin as a pivot point, and that’s the entire reason we can indicate “No” to someone without having to use words. Left and right rotational movement - The Donut (carrying your skull) swiveling around this pivot point - got it? Yes, there will be a quiz at the end of this.

So when I crashed headfirst into the ground, a couple things happened.

First off, imagine taking a donut (in my head, for some reason, it’s always a sour cream donut - something about the shape of those makes me think of the bony ridges and processes of the cervical spine vertebrae) and dropping it on the kitchen floor from about chest height or so. Incredibly sad. Donut on the floor, probably split into multiple pieces. (Quick, 5 second rule, it’s still edible if you move fast!) That’s what happened to my Donut. It effectively cracked in three places - two sections along the back of the ring and one diagonal fracture towards the front and side. Unfortunately this did not qualify me for the very cool-sounding diagnosis of a “Jefferson Fracture” (named for Sir Geoffrey Jefferson of medical fame, not the 3rd POTUS, I don’t think HE was ever cool enough to break his neck) - this requires a “burst fracture” in four separate locations, and mine was only nice enough to break in three. So close!

Moving down the cervical spine, we find out what happens when force is rapidly applied to The Pin of C2 as The Donut around it gets thrown violently around. In this case, it decides to snap right off. This is naturally a serious - but also the most common - type of injury to C2, since that pin is sitting there like a turkey wishbone just waiting to be snapped. This is why I immediately couldn’t turn or move my head at all right after the injury - with that connection broken between C1 and C2, suddenly that whole pivot joint mechanism is very much non-functional. Some of my reading over the last month determined that one of the decisions between Halo brace natural healing vs surgery is based on how far this pin moves once it is snapped. There’s about a 5mm threshold, it seems - where if the pin bone moves out of place by more than that about there’s a much lower chance of being able to get it to reattach and grow back to where it should be on the base of C2. Mine moved approximately 4mm - any more and surgery might have been the only option.

C3-C7 are much simpler bones, they are sort of like building blocks that just go down the rest of your neck spine. My C7 had a bit of a compression fracture but nothing nearly as serious as what was going on up near the skull (had it been only the C7 fracture I suffered, Dr. Lynn said they would have put me in a hard neck brace for a few weeks and called it a day). As it was, in comparison to what was going on up in C1-C2, C7 was almost an afterthought by comparison.

I also learned - from one of the doctors in the emergency room - that your spinal cord controls more and more vital functions the further up it goes. So if you damage your spinal cord at C6-C7, you might suffer loss of function and control of your legs or lower body. Getting up towards C4-5 you’re talking much higher risks of becoming quadriplegic. The C1-C3 area is where autonomous breathing functions are located (this is the area that actor Christopher Reeve of “Superman” fame damaged in his horseback riding injury) - the doctor pointed out very kindly that had C1 or C2 been jolted enough to cause any spinal injury in that area, I very probably would have just suffocated to death in that ditch. Fun!

But with no spinal injuries, it was just a matter of determining how the bones could be put back together. Screws and pins would do it, a la the surgery option - but since C1-C2 control your neck rotation, that’s why you lose some of that functionality after such a procedure. Metal screws and bolts are great for holding things together, but not for allowing everything in your neck to work precisely the way it was designed. So, the Halo brace immobilizes everything while the bones grow back together, and here we are.

Anyway, yeah, thanks for coming to my TED Talk about neck bones.

So the report on the first post-op x-rays was very good. Fractures can still be seen in several areas, naturally, but everything is lined up where it should be and that’s exactly what we want after one month. Amanda, the PA, said we usually don’t start seeing actual “fusion” of the neck bones until 8-12 weeks, so hopefully we’ll get an even better report at my next check-up in early November (assuming Dr. Lynn doesn’t have to reschedule on me 4 more times). Mostly I’m really curious to get his opinion on my injury as a whole and ask him some specific questions (especially about the procedure when he “set” the neck bones and they put on the brace) so look for more reporting on that subject down the road.

Otherwise, life is good and I’m really feeling fine. It seemed to take about 4 weeks for my body to really “get used” to the Halo - it’s still awkward and cumbersome, but MUCH less so than it was those first couple of weeks. The human body is remarkably adaptable. As odd as it sounds, the screws in my skull aren’t even uncomfortable now, I just register their presence but there’s no pain at all, just a slight pressure. And most days, the neck itself feels pretty good. I’m still mostly sleeping sitting propped up in a chair - it just seems to be the most comfortable position overall - and I’ll wake up most mornings with a lot of stiffness or a sore spot in my neck, but it almost always works out pretty quickly after I get up and move around. Work keeps me busy, Graham keeps me entertained, and Lindsay keeps me from doing anything stupid that I shouldn’t, so all-in-all - the prognosis is good!

Oh and just wait, the next post is gonna be about “pin care” on the screw sites in my skull and that’s gonna be REAL fun. Stay tuned!

Edit - The Next Post - Pinsite Fun

First post-op Xray after a month - 
Pin bone aligned and beginning
to reattach

CT Scan day of the injury -
"The Pin" of the C2 circled