C1 & C2 Spinal Injuries

The C1 and C2 vertebrae are the first two segments in the cervical spine. These levels of the spinal column are especially important due to their location and functions. A C1 through C2 vertebrae injury is considered to be the most severe of all spinal cord injuries as it can lead to full paralysis—but is most often fatal. 

Depending upon their severity, these types of spinal cord injury are either categorized as complete or incomplete.

C1 Spinal Vertebra Defined

The C1 vertebra is the first of seven vertebrae in the cervical region. It is connected to the head and leads into the C2 vertebra.

C2 Spinal Vertebra Defined

As C2 spinal vertebra is the second of the seven cervical vertebrae and follows the C1 vertebra. As the first two segments in the cervical spine, the C1 and C2 vertebrae support the head. 

Names of the C1 and C2 Vertebrae 

The C1 vertebra is also known as Atlas, with the C2 vertebra named the Axis. While the C1 Atlas vertebra is named after the Greek titan who supported the weight of the world in myth, the C2 axis vertebra is labelled because of its purpose of motion: the atlas vertebra pivots on the axis vertebra, which allows the head to rotate.

The C1 and C2 vertebrae are also responsible for allowing the head to rotate and swivel since the atlas C1 is directly attached into the skull and pivots from the C2 axis. 

C1 and C2 Anatomy

The C1 and C2 vertebrae are part of the seven vertebrae that make up the cervical column that supports the neck and head. Although the cervical vertebrae are some of the smallest, they have to support the weight of the head and protect the spinal cord, the bundle of nerves that relays messages between the brain and the rest of the body.

The C1 and C2 vertebrae are uniquely shaped and have vertebral foramen (spaces within the bone) which allow the vertebral arteries and veins to reach through to the brain and supply it with blood. This unique formation is only seen in the cervical vertebrae.

Functions of C1 and C2 

The role of the cervical vertebrae is to support the neck and head, as well as protect the spinal cord from injury. Types of spinal cord injury to the cervical vertebrae are so severe because the higher the injury on the spinal cord, the more damage and loss of function the individual will experience.

Since the C1 and C2 vertebrae are the most high up, they are very important for supporting the skull, allowing for the head to rotate, and protecting the spinal cord. If they become damaged, then the nerves carrying messages from the brain to the rest of the body are also affected. 

The Relationship Between the C1 and C2 Vertebrae

The C1 and C2 vertebrae function together to give your head flexibility. With the atlas and axis relationship, you are able to swivel and rotate your head, as well as support your head. These two vertebrae are more responsible for the head’s rotational range of motion than from any other joint. 

C1 and C2 Spinal Cord Injury Causes

Although injuries can occur at this level, they are not very common. Medical professionals see more injuries to the C4 and C5 area. The most frequent cause of a C1 spinal fracture is diving, followed by vehicular accidents, and then falls that impact the head.

Other common ways to sustain a cervical vertebrae injury are:

• Trauma, such as sports-related injuries
• Car accidents
• Slip and/or fall
• Congenital abnormalities
• Diseases
• Tumors
• Infections

C1 and C2 Symptoms

Patients that survive a C1 through C2 Vertebrae Injury will likely have the following symptoms:

• Inability to breathe without assistance from a ventilator
• Inability or reduced ability to speak
• Loss of feeling or sensation below the level of injury
• Paralysis in the arms, hands, trunk, and legs
• Limited neck and/or head movement

C1-C2 Vertebrae Injuries: Breaks, Fractures and Misalignments 

Since these vertebrae are so high up on the spinal cord, a C1 through C2 vertebrae injury is considered the most severe. Injuries here have the potential to remove impulses to the rest of the body below that point. Due to their position on the spinal column, having a C1 or C2 vertebrae out of place, or an injury such as a spinal fracture, most often either leads to death or complete paralyzation.

In addition to the injury, any interference at the C1 and/or C2 level can cause the vertebral arteries to inflict neurological damage, leaving the brain without a vital source of blood.

Symptoms following a cervical vertebrae injury to the atlas C1 and axis C2 may include:

• Complete paralysis of arms and legs
• Muscle atrophy
• Limited head and neck movement
• Compromised continence control
• Trouble breathing without apparatus and assistance
• Ability to speak reduced or impaired

Surgical and Nonsurgical Treatments for C1 and C2 Injuries

Treatment options for vertebrae injury at the C1 and C2 levels will not reverse the damage. Survivors of cervical spinal cord injuries at this level will likely require assistance for the remainder of their lives. Treatments are done to provide symptom relief, prevent further spinal cord damage, and to aid the patient in using the remaining function of their body.

Current treatments for C1 and C2 SCIs include:

• Surgery to relieve pressure from the spinal cord and fuse the affected segments together to prevent movement (movement could lead to further damage to the spinal cord).
• Prescription drugs to aid in the recovery of sensory and motor function, as well as to reduce inflammation in the affected area.
• Physical therapy to strengthen other areas of the body so the patient can learn to use the remaining body function. 

C1 and C2 Spinal Cord Injury Recovery 

The outlook of a person’s recovery from a cervical vertebra injury depends on a variety of factors, including:

• Their health at the time of their injury (body type, existing medical conditions, etc.);
• How soon they received treatment and their injury was stabilized;
• The completeness of the injury;
• Whether anti-inflammatory and steroid medications were used after the injury to relieve swelling and pressure on the spinal cord;
• Whether the SCI survivor went through therapies and treatments at a rehabilitation facility that specializes in spinal cord injuries; and
• Whether the patient, their friends, family, or caregivers stick with a consistent care plan to aid their recovery.

Powered wheelchairs can also help people with a C1 through C2 vertebrae injury get around since they are equipped with special assistive technologies that allow them to control the chair’s movement through unconventional means. However, people with these injuries will still require 24-hour care and assistance from family, friends, or a professional caregiver (or multitude of each).

Medical researchers are continuously looking for treatment options for spinal cord injury patients. The use of stem cells has shown promising results in regenerating function lost due to this debilitating injury. Injecting these cells into the injured spinal cord may improve overall function and aid in the recovery of the spinal cord. Although this research is still in its infancy, human patient studies have reported improved walking and sensory perception.