[Kxbritt]

#27980

I am 57 years old and was in a low impact side accident 1 year ago.

Diagnosis’s from all providers:

M52.838 – Muscle Spasm
M54.2 – Cervicalgia
M47.812 – Spondylosis without Myelopathy or radiculopathy
M24.28 – Ligament Laxity
M54.6
M53.84
M54.30
S12.54A

X-rays show: (5 views lateral projection)
Retrolisthesis of C5-C6 (2mm)
Moderate disc disease C5-C6 and C6-C7
Mild multilevel cervical facet joint hypertrophy
Mild bony foraminal noarrowing left at C5-C6 and C6-C7
Moderate neural foraminal narrowing on right C6-C7
Mild bony neural foraminal narrowing on right C5-C6

Impression: Multilevel degenerative changes of cervical spine most prominent at C5-C6 and C6-C7.

MRI shows:
Mild anterolisthesis of C3 with respect to C4 and mild retrolisthesis of C5 with respect to C6.
C3-C4: No significant disc disease. Left uncovertebral join hypertrophy and face arthropathy. Mild left neural foraminal stenosis. No significant central canal stenosis.
C4-C5: No significant disc disease. Mild bilateral facet arthropathy. No significant central canal stenosis. No significant neural foraminal stenosis.
C5-C6: Broad based disc osteophyte complex, bilateral uncovertebral joint hypertrophy and bilateral facet arthopathy. Mild central canal stenosis and moderate left as well as moderate-severe right neural foraminal stenosis.
C6-C7: Broad based disc osteophyte complex, right greater than left uncovertebral joint hypertrophy and facet arthorpathy. Mild central canal stenosis as well as moderate-severe left and severe right neural foraminal stenosis.
C7-T1: No significant disc disease or facet arthropathy. No significant central canal stenosis. No significant neural foraminal stenosis.

Impression:
1. Degeneratie changes resulting in varying degrees of central canal and neural foraminal stenosis, as detailed above.
2. Mild anterolisthesis of C3 with respect to C4 and mild retrolisthesis of C5 with respect to C6
3. Mild cerebellar tonsillar ectopia.

I have been to a chiropractor, an urgent care physician, a D.O, another chiropractor who is also a certified neurologist and 2 pain care Doctors. I have undergone chiropractic tx accompanied by physiotherapy exercises, had 2 sets of x-rays and an MRI. The x-rays were also analyzed with digitalization. I have also had cervical facet injections at C5/C6 and C6/C7 followed by radiofrequency ablation. The dull aching pain has gone away after the ablation, but the shooting pains with movement of my neck (left and right) and especially backwards extension have not improved at all. The Pain Dr. now wants to do another ablation at C7/T1.

The chiropractor/neurologist says my condition is static and that I have ligament laxity due to a 4.1 translational movement of C3 and C4. (Digitalized x-rays through spine institute with reviews by Robert Peyster MC, CAQ Neuroradiology, and references to the journal of neuroradiology and a whole bunch of other experts I don’t understand) The chiropractor says this is a permanent injury that this is an impairment and that I need ongoing lifetime treatment. He says I will experience accelerated degeneration and due to bone on bone, I might have further complications possibly to include surgery down the road. He says ongoing chiropractic care will slow the process down. My D.O. says he doesn’t know, but that this chiropractic opinion “may not represent full evidenced based medicine” and “there might be impairment, but that doesn’t mean disability”. He does attribute the findings of anterolisthesis and retrolisthesis to the accident, and also notes degenerative conditions not related to the accident. (he relates all my symptoms as I never had any neck issues before the accident) He recommended conservative pain care treatment, but said I could go to a neurosurgeon, but he doesn’t think I’m surgical right now. The Pain Doctor is attempting to get me symptom free via ablations, but says these are temporary and may need to be repeated. She is not commenting on causation, or ligament laxity.

It is my understanding that injections themselves can cause accelerated degeneration and therefore shouldn’t be repeated on an ongoing basis and that ablations can alleviate pain for a period of time, but are not curative and can increase the risk of other future injuries. I am being told they do not cure or heal an injury, but can alleviate symptoms. After my cervical ablation I have new pain in my shoulder that does not seem to be going away, so I am a bit reluctant to have the additional ablation at C7-T1.

So, my questions are:

1. Why so many opinions and who is right?
2. What is my injury and what do I need?
3. Is ligament laxity a legitimate diagnosis and is it permanent. Do I need ongoing chiropractic?
4. Do repeated injections accelerate degeneration? Are repeated ablations the direction I need to go or do they present other risks for new injuries? (AKA…will the shoulder pain I have experienced beginning immediately after my first ablations go away? Might I need a future surgery related to this injury?

No one will tell me and the answers I do get are vague and very different from each other, which is confusing.

I was happy to see that you are an MD, a DC, and a spine surgeon. If anyone can answer these questions, I’m hoping it would be you.

How much do you charge to do a complete records review?

[Donald Corenman, MD, DC]

#27997

First, more likely than not, you had many if not all of these preexisting problems in your neck if you had a low speed accident. You simply had no symptoms form then and this accident was unfortunately subjected to just the right amount of force to trigger these to become painful.

This paragraph is unfortunate “The chiropractor says this is a permanent injury that this is an impairment and that I need ongoing lifetime treatment. He says I will experience accelerated degeneration and due to bone on bone, I might have further complications possibly to include surgery down the road. He says ongoing chiropractic care will slow the process down”.

You should not need lifetime treatment. Degeneration will not be accelerated. You possibly could use surgery to treat your symptoms but now is not the time. Chiropractic care will not slow down the degenerative process.

You have degenerative disc and facet disease with foraminal stenosis. These disorders do have some relationship to some ligament laxity but I would not characterize your disorders ad ligament laxity. Interestingly, if this really was a true ligament laxity case, I would say chiropractic treatment is contraindicated but in your case since you really don’t have ligament laxity, it is not contraindicated.

Ablations take care of facet mediated pain. The key is how you feel for the first three hours after a facet injection. If you feel “great” and most of the pain is gone, then get ablations. If you have 50% or less pain relief, the facets should be left alone.

I charge 500.00 for a complete records review, imaging review and history/discussion on the phone called a long-distance consult.

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.

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