Nonoperative treatment with immobilization can be done using a halo-thoracic vest. The vest is kept on for up to four months. The surgeon relies on X-rays to show if healing is taking place before transitioning the patient to a stiff cervical collar for another four weeks.
This type of management is possible when the fracture is nondisplaced (hasn't moved) and the patient is without symptoms. The very young and very old are treated with conservative care most often.
Nonunion of the fracture (failure to heal) can occur requiring follow-up fusion surgery to achieve spinal stabilization. Patients with diabetes, rheumatoid arthritis, or other serious health conditions seem to be at increased risk for delayed healing or nonunion.
When surgery is done to fuse the C1-C2 segment, immobilization with a soft or hard collar is used for at least six weeks -- sometimes longer. Rehab to restore overall neck motion and function takes place six to 12 weeks after surgery.