[GMiller]

#29878

Dr. Corenman, I am a 54-year-old male airline transport pilot who on Aug. 19, 2018 was involved in a motocross (dirt bike) racing accident-causing hyperextension of my neck resulting in cervical spinal fractures.
I was transported to an East TX hospital ER/ICU unit and put through CT and MRI imaging along with other vital testing protocols. A rigid cervical collar was placed on my neck and the attending trauma physician quickly stated that I had ‘broken my neck” and I was to be placed on observation for the next 24 hours. I then was pushed into a room for the next 30 hours with no food or water pending possible surgery. This was probably the most horrifying and torturous experience of my entire life. For those 30 hours, I only saw a routine nurse that came by every 2-3 hours to check my vitals and then walk away. I had zero interaction or consultation from any doctor during this time until my partner and I demanded that I have a doctor come and explain what my condition was and the plan of action. I was simply told that I had some fractures and most likely Central Spinal Cord Syndrome at the C6 level, told to wear a rigid collar and come back in 8 weeks.
I experienced intense burning bilaterally in my hands – primarily in the thumb and index finger, but also numbness/weakness in the arms and shoulders. I also experienced bilateral numbness on the bottom of my feet.
The lack of care I received was beyond imaginable and I self discharged myself after 34 hours. I immediately found an orthopedic surgeon back home in Fort Worth that took a couple of weeks to see.
It has now been almost 4 months post injury and I have had a new MRI, which did indicate fractures and some cord trauma. The nerve pain, burning and muscle weakness now seems to be getting worse. My neck doesn’t actually hurt that much at the moment. My intensifying issues are the increasing nerve pain and continued loss of hand grip/strength. I also present with Lhermitte’s Sign although it has reduced in intensity quite a bit since the first month.
The Orthopedic doctor is advising that we proceed with an ACDF C5 thru C7 to relieve nerve and cord compression. And that is about all we can do for now to hopefully alleviate the intense nerve/muscle problems. He isn’t quite agreeing with the previous hospital’s Cord Syndrome diagnosis yet and wants to see how I respond to the ACDF procedure.
Right now my life is on hold and that is how bad the pain has become. Unfortunately at the time of my injury, I was in the process of changing air carriers to work through retirement and did not have company insurance. So all this is out of pocket and has financially strained me. Couldn’t have been worse timing and probably bad judgment on my part for partaking in my favorite pastime, but it happened and I am determined to recover some how and regain my life back. Below is the MRI and CT report from the original hospital admission. My current doctor supports these findings minus the Cord Syndrome diagnosis. He seems interested in helping and very surprised at the lack of care I received the day of my injury.
Dr. Corenman, could you please read through this report and give me your opinion on my experience and situation?

C2-C3: Diffuse dorsal ridging narrows the ventral thecal space without cord flattening.
C3-C4: Dorsal ridging narrows the ventral thecal space. There is mild ventral cord flattening. Uncovertebral joints arthropathy with mild/moderate bilateral neural foraminal narrowing.
C4-C5: Diffuse dorsal ridging narrows the ventral and dorsal thecal space and mildly flattens the ventral cord. Vertebral joint facet arthopathy with mild RIGHT neural foraminal stenosis.
C5- C6: There is some diffuse disc ossify complex ridging. No definitive epidural fluid collection the significance although there may be a trace dorsal epidural fluid collection behind the C5 vertebral body extending down to the C5-6 disc. There is near effacement of the ventral and dorsal cord with mild ventral and dorsal cord flattening. There is uncovertebral joint facet arthropathy with severe RIGHT and moderate to severe LEFT neural foraminal narrowing.
C6-C7: Diffuse dorsal ridging narrows the ventral and dorsal thecal space without cord flattening. There is uncovertebral joint facet arthropathy with mild bilateral neural foraminal stenosis.
C7-T1: There is no significant canal or neuroforaminal stenosis.

FINDINGS: There is abnormal signal within the interspinous ligament at C5-6. There is disruption involving the interspinous ligament and disruption involving the ligamentum flavum at this level. There is a fracture involving the C6 spinous process and adjacent lamina. There is also some edema associated with the LEFT lateral mass of C6 indicative of underlying fracture in this region. The vertebral body heights are well maintained. There is mild multi8level loss of normal disc space height throughout the cervical spine. There is some trace retrolisthesis of C5 of C6. The spinal cord is normal in course, signal and morphology. The posterior fossa structures are normal.

IMPRESSION: fractures of the cervical spine are better seen on the CT. there is edema in these areas indicative of acute fracture. There does appear to be significant ligamentous disruption involving the interspinous ligament and ligamentum flavum at the level C5-6. At this level there is a diffuse disc ossify complex ridging ventrally and in combination with the likely small dorsal epidural fluid collection there is significant narrowing and flattening of the ventral and dorsal aspect of the cord.

[Donald Corenman, MD, DC]

#29888

Sorry to hear of your initial hospitalization. You should have had a long talk with the spine surgeon who should have given you the full plan of what you could have expected for treatment, surgery and future recovery.

See central cord syndrome in this section: https://neckandback.com/conditions/spinal-cord-injuries-neck/

You had a flexion injury to the cervical spine which tears the posterior ligaments and causes fracture or disc disruption of the anterior column (vertebral bodies and discs). This angulation caused the cord injury with what you report is a central cord syndrome (see the section above).

In my practice, I would have operated within your first hospital stay to take pressure off the cord and allow you to heal in the first 6 weeks. I am not sure of the appropriate surgery as you have a number of levels involved and I also depend upon the cervical X-rays to let me know alignment and stability along with the MRI findings.In your case, a CT scan would be helpful too.

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.

[GMiller]

#29893

Thank you Dr. Corenman for responding.

Yes, I agree with having the long talk with the original doctor, but after repeated attempts from both myself and my partner, we received almost no guidance or professional care and thus the reason for my leaving and seeking another opinion here in Fort Worth.

I did indeed receive CT images and here are the findings per the report given to me.

FINDINGS:The occipital condyles, C1 and C2 vertebra are intact with a normal C1-2 relationship. The C3 and C4 vertebra are intact. There is fracture through the LEFT facet at C5-6. There is a non displaced fracture of the LEFT lamina and posterior spinous process of C6. The C7 vertebra is intact. The cervical vertebra and facet joints are normally aligned. No canal stenosis is seen.

IMPRESSION: 1. There are fractures involving the LEFT inferior facet of C5 and LEFT superior facet of C6, LEFT lamina of C6 and posterior spinous process of C6. Anatomic alignment is seen.

I do present with a fairly strong Lhermitte’s Sign and the burning is very intense in both thumbs. Left hand wrist flexors are also very painful upon waking then they settle down during the day. I has weakness mostly on the left side of my upper body, but there is paralysis on both sides and both feet have slight numbness.

Is it your opinion that I did receive some cord damage and possibly suffer from Central Cord Syndrome? Would the ACDF surgery help in decompression of the nerve bundles at C5-C6 & C6-C7 and possibly reduce the hand pain? At the moment this is my chief complaint – intense burning numbness and weakness of the hands and wrist.

Thank you,

George Miller

[Donald Corenman, MD, DC]

#29897

You most likely had a flexion subluxation injury to C5-6. Subluxation means the vertebral alignment shifted which compressed the cord causing central cord syndrome and the subsequent “burning hands syndrome”. This is predicated on the fact that you have both hands burning as if it is only one hand, this would be nerve root injury and not cord injury.

If you still have a Lhermitte’s sign, I think you still need stabilization. Depending upon your CT scan and x-ray findings, you should need an ACDF at C5-6.

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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