QUESTION: My question pertains to rating impairment for C1 and C2 fractures using the Sixth Edition. The DBI regional grid for vertebral fractures bases classification on the percentage of compression, without an option to rate based on C1-2 range of motion (axis and atlas maneuvers). The AMA Guides do not adequately address the unique anatomy of C1 and C2 versus other cervical vertebrae; and measuring compression is inadequate to assess impairments of the atlas and axis. Thoughts??
ANSWER: Unlike those of C3 through C7, common fracture patterns for C1 and C2 do not involve loss of vertebral body height. There is rarely neurologic deficit, as there are no motor branches of significance from C1 and C2 roots. The sensory branches/roots are usually uninjured, or there is so much overlap of sensory innervation the deficit is undetectable. There is...
