Is surgery always needed for a fracture of the bones at the very top of the neck?
The upper cervical spine starts with two bones labeled C1 and C2. C2 has a peg-like bony structure called the odontoid process. It sticks up like a tooth through the round ring that makes up C1.

A fracture of the odontoid process can be very serious. If it is unstable, the bones slip. Pressure on the spinal cord can cause permanent neurologic damage. Paralysis is even possible. For this reason, fusion of the spine at the C1-2 level is usually advised.

Surgery is done to stabilize the fracture and prevent neurologic problems and complications. Sometimes, older adults who are inactive can be treated with nonoperative management. The risk of anesthesia may be too great or there may be other health concerns preventing surgery.

Without surgery, the patient may experience neck and head pain, stiffness, and loss of cervical spine motion. Occasionally, dizziness and weakness of the arms occurs. But these symptoms are far more manageable than permanent paralysis of the chest, arms, and lower body.

With care, nonoperative management can be successful for those patients who can't have surgery for some reason. This type of treatment can work well for patients who don't have any symptoms and who have a stable, fibrous union of the odontoid. Most of the time, fusion is strongly advised and provides good long-term results.