Possible cervical neck instability: Questions for Treatment

Tagged: atlantoaxial Instability, c1 c2 instability, CHRONIC NECK PAIN, concussion, post-concussion syndrome, prolotherapy, treatment, Whiplash

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Nphillips
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December 10, 2015 at 9:16 am

Post count: 5

#21010

Let me start with a quick description of my injury, followed by my symptoms to give the best idea possible of what the options are.
I am a 28 year old female, with a relatively high activity level before my accident.
Injury: In January 2015, I was playing around with my husband in some big waves on vacation in Barbados. Walking back to shore in about 3-4 feet of water an enormous wave pushed me face down into the sand, hard enough to bruise my face. I became caught in the force of the weave as it was about to curl. My feet got swept up into the wave and as the wave broke I was suspended with my back hyper extended backwards, and as it came down my bum basically hit the back of my head. On impact, my left shoulder and right side of my face made the first impact on the sand which meant my neck was twisted during the impact. On impact my face, all the way down to collar bones where in contact with the sand and the rest curved backwards over top of me. I had an immediate headache when I was able to get out of the water. I had severe whiplash, and dizziness the remainder of the trip. When I got home I was diagnosed with whiplash, concussion, and a jammed neck (the joints at the base of my skull were likely compressed). I also likely sprained my neck according to my doctor and chiropractor due to the amount of hyper-extension I experienced.
Some of the pain has left me now, specifically the pain in my mid back has completely disappeared, but for several months I have reached a plateau in my healing and I can’t seem to figure out why.
Current symptoms:
-Dizziness, especially when tired, exercising, or when closing my eyes
-Eye ticking when following a pencil across my vision
-Tinnitus
-Fullness in ears
-Depressed mood
-a constant dull ache at the base of my skull, hurts more at the end of the day. The pain spreads to temples often.
-If I fall asleep with my head turned to one side, I will wake up with a rush of blood going to my head, and a painful headache for the remainder of the day. Feels as if the circulation to my brain is literally cut off.
-On days when I wake up in a badly made bed(like the air mattress at my sister’s house), or after a long day the day before, when I turn my neck it sounds like I am breaking apart a glow-stick. After several rotations, the crunchiness decreases, just like after several breaks in a glow stick the crunching decreases.
-My head will shake involuntarily when I become extremely tired. (I look like a bobble head)
Symptoms are brought on or exacerbated by:
-Exercising with too high a heart rate
-Exercising lightly, but too many days in a row
-Muscle tension in shoulders and neck
-A long day at work
-Having a few drinks with friends
-Eating unhealthy at a party (possibly from eating foods that cause inflammation)

*** While I make a concerted effort to avoid the things I can by eating well, trying to stay active within reason, and avoiding getting tired, it’s safe to say that life still happens, so it’s not always possible to be perfect. Even on weeks when I am on my best behavior, I still experience the suboccipital pain daily just from holding my head up. My quality of life is not what it used to be. I have put on weight from the contrast in activity before vs. after the accident, which has caused my self esteem and over well-being to decrease. I used to go to three spin classes a week, two personal training sessions a week, and had an ass that wouldn’t quit. Now I am 20 pounds heavier, I am in constant pain, I forget things, I am depressed, and I just hate living like this. I can’t seem to get any better, even with chiropractic care, ART, acupuncture, massage, NSAIDS, and heat.

1.) Will this heal on it’s own eventually? The nature of the injury was very traumatic. I was told, worse than a car accident, because at least in a car you are strapped in while experiencing the force. I was tangled, chewed up, swallowed down, and spit out by the Caribbean Sea. Is it just that I am not being patient enough?
2.) Could this be C1-C2 instability, or atlantoaxil instabilty?
3.) If so, should I consider Prolotherapy?
4.) Are there any treatment options you can think of that I may have overlooked?

This website is wonderful. I have found more on this one website, than I ever have in months of research I have been doing. Anything you can suggest or answer for me is very much appreciated.

Thank you in advance for you time. I know it is valuable, and I appreciate it.

~Nicole

Pbean
Participant

December 10, 2015 at 1:50 pm

Post count: 2

#21012

Hi Nicole,

It has been a year since the injury, if all were well, you should not have these symptoms.
What do your Dr’s say about it, and have you gotten a 2nd opinion?
I am a big advocate of 2nd and sometimes 3rd options after having spine surgery 7 years ago and finding out it was the wrong surgery and no wonder didn’t work.
7 years if chronic never-ending pain has taught me the value of another opinion.
I didn’t get one because this particular Dr. came so highly recommended.
Never again!!

Nphillips
Participant

December 11, 2015 at 9:16 am

Post count: 5

#21014

Thanks, Pbean.
How very true on second opions. I saw my doctor once in June, and he simply told me to come back if problems persist in a month’s time. Then he repeatedly took one month holidays (1 month off, 1 month back and fully booked because of his absence, then repeat to holidays again). I finally have an appointment with him on the 23rd and will be insistent on a specialist referral. Right now I have three chiropractors (they work together and have all treated me) and my doctor’s opinion, as well as my doctor’s fill-in guy, all who agreed with diagnosis of concussion and whiplash. However, I think what you are suggesting is to get one or two opinions of people who specialize in this sort of injury, which I definitely agree with, and that I haven’t done yet. The Atlantoaxial instability is something I am convinced I have, only because it’s the first time I have read about a type of injury/condition where I have every single symptom. What I need is a specialist or a few specialists to decide whether or not this is true, and if I do, then where to go from there. I knew in my gut that I should have had a more thorough examination. I only had x-rays done on my back (because shortly after the accident, one of my vertebrae was extremely tender to touch). I wish I had X-rays of my neck as well, because I think there has been some structural damage to it that should have been caught. I have been getting regular adjustments at the chiropractor, and perhaps I shouldn’t be manipulating that area of my neck. What if they accidentally did permanent damage?
The other thing with injuries like this is everyone thinks you’re sort of being a cry baby about the pain, or that your pain has became psychosomatic (all in your head) after a certain amount of time has passed. This couldn’t be further from the truth. I am sick of being sent home and being told “come back if it’s still there in a month, and make sure you take of yourself”. I only ever feel like a burden to my doctor, and I even think my chiropractor is getting a little sick of me. I sense she thinks that because on the odd day I forget my supplements or forget my eye exercises and stretches that that is the reason I am not well yet. I doubt missing few days here and there of exercises and supplements can have that affect on me. Treatments lately have been zero help to me, and I think I have done some damage that needs treating that isn’t being addressed yet.
And Pbean, I am sorry to hear about your surgery mishap. That is terrible and extremely unethical of that doctor to have done that to you. He clearly wasn’t 100% sure what he was doing and should have done you the courtesy of getting another opinion himself or having you get one. Having an extremely invasive, likely high-risk surgery on your spine only to find out it didn’t help and wasn’t even needed is a terrible realization. I would be furious to have been treated that way. I am sorry for your lost years of pain too. I hope you are moving on from it, and that you are feeling better. I appreciate your sharing. It’s nice to not feel alone. Onward and upward.

Donald Corenman, MD, DC
Moderator

December 13, 2015 at 6:40 am

Post count: 8660

#21022

By the sound of your injury symptoms, you had a concussion. Many of your symptoms fit this that diagnosis. We are just now learning about concussion and how the brain heals as you probably are aware from the NFL controversies. Your “head” symptoms (dizziness, thoughts cloudy, general feeling of fatigue) are from this brain injury most likely.

Your other symptoms of base of skull pain and popping in your neck are most likely from facet injury in the upper neck. You need a consultation from a spine surgeon, thorough physical examination, motion X-rays and probably an MRI or CT scan to determine if instability is present.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Pbean
Participant

December 21, 2015 at 3:03 pm

Post count: 2

#21054

Interesting Dr. Foreman, I have never heard of a motion xRay. What does this do? Sounds odd since they want you to hold your breath and be still when getting an x-ray. I wish I still lived in Colorado, I would definitely come see xRay.Please consider opening an office in Nashville!

Nphillips
Participant

December 21, 2015 at 4:37 pm

Post count: 5

#21055

Thanks for your time, Dr. Corenman. Would the type of injury your are suggesting be something that could get better with time? Or should I pursue specialist treatment.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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