I have an old C2 injury from a 2001 wreck (my compact car was t-boned by a full sized SUV at highway speed -- the driver ran a light on a road with a diagonal approach over my left shoulder blind spot). Two fractures in each major spine region, lumbar, thoracic and cervical, but the C2 was the one that bothered me for years and continues to be a problem -- headaches, dizziness, etc.
I didn't pursue a fusion back then. I was skeptical about whether the risks outweighed the advantages. Both of my grandparents had lower back spinal fusions that didn't seem to help at all. And my mom and dad had alternative procedures that didn't seem to help much.
I'm being reevaluated this year. My ortho and endocrinology docs noticed some lingering C2 problems in X-rays after I had unrelated problems last year -- hit by a car last May, breaking my shoulder, and thyroid cancer. The C2 issue was shuffled to the bottom of the priority list. However the shoulder and thyroid issues seem to be under control.
After meeting a younger fellow who had extensive fusions (he's a former EMT or paramedic who was hit by a passing car while he was stopped rendering aid to another victim), I'm more likely to consider a fusion now if it's recommended because techniques have improved. But I'd rather not unless it's absolutely necessary. In the case of the younger fellow, the fusions only delayed the inevitable decline. I met him during a cross country bike ride, which he finished last summer. At the time he was still in a lot of discomfort but realized he might not get another chance if he waited. He road a drop bar touring bike with the bar at saddle height. Ergonomics looked good. But short of an upright bike -- impractical for a 3,000 mile ride unless they planned on shorter trips per session, a lot of stops and a much longer timetable to finish -- nothing would be comfortable.
Over the years since 2001 the C2 went from being splintered into at least three pieces into what appears to be a solid but oversized mass now. I can feel some grinding when I turn my head or stretch. And there's always some lingering discomfort. But I'll wait until after the ortho consults and diagnostics this year.
When I resumed cycling in 2015 I started on an upright comfort hybrid, with suspension fork. I still have it as an errand bike. It's very heavy but solid for hauling groceries. I divide my rides about evenly between a solid frame/fork hybrid with albatross bars and an older steel road bike.
The hybrid albatross bar is right about at saddle height. The swept back bars reduce the reach of the long top tube so it's comfortable with surprisingly versatile hand positions -- occasionally I'll lean into the forward arced part of the bar and it feels just like riding the hoods on a drop bar touring bike. I can ride that bike all day at a casual pace and usually put in around 40 miles, longer when the weather cooperates.
The road bike bar is about 2.5" below saddle height. I can manage 20-30 miles without stopping, other than to stretch for a minute halfway through. I tend to just do workouts on that bike on familiar routes. I don't often ride it casually or in casual group rides, but I might tonight since it's extremely windy -- 20-40 mph wind, but too nice a day to waste. The wind should calm a bit later today. If all goes as planned I'll put in 40 miles or so by the time I get home, but it'll be a leisurely pace with lots of brief stops, so it should be manageable on the neck and shoulder.
For now, century rides are out. I have ridden several metric centuries -- 60+ miles -- on all of my bikes, but beyond the 75 mile mark of attempted centuries it just became painful and not at all fun. I rode one full standard century in November 2017 and had no desire to repeat that experience. Perhaps after more work on the C2.
I will admit that I've responded pretty well to home physical therapy. I've consulted with physical therapists for exercises but they say I'm doing more on my own at home so they said it wasn't necessary for me to come in for regular sessions. But it took me more than a decade to get to that point.
My daily ritual involves a lot of routine pain management -- stretching, topical analgesics, massage, etc. Due to the thyroid condition my energy level is still pretty low so I'm a slow starter. Most of my workouts don't start until late afternoon. Occasionally I'll do an easy spin on the indoor trainer to get the blood flowing. And I do stretch before bike rides and workouts -- I know it's a controversial and some folks decline to stretch, but it works for me.
I use some prescription and non-prescription anti-inflammatories -- diclofenac and bromelain (pineapple enzyme, a remarkably effective anti-inflammatory). I try to avoid prescription pain relievers and use them only a few times a month when nothing else works. Typically a "30-day" supply of hydrocodone or cyclobenzaprine will last me 3-6 months, so the docs are willing to renew my pain meds occasionally since I don't use them too often.