[Pete1221]

#21445

Dr. I have been experiencing a whole host of issues shortly following a fall where I impacted my head June of 2014. Although the fall and impact was definitely violent I did not experience much of any pain and therefore did not get checked out professionally after the accident, probably a big mistake. About two weeks after the accident I started coming down with horrible symptoms of dizziness, vertigo, tinnitus and many others. But since there was no pain involved I did not suspect my neck or spine. Fast forward to now I have been through the medical and diagnostic ringer. I have had every test and seen every Dr possible it seems. Just recently I had a dynamic CT scan of the upper cervical region with both left and right 60 degree rotation performed. The impression on the radiology report states “findings suspect of a moderate atlanto-axial subluxation”. ” moderate degenerative changes at the anterior atlanto-axial joint” the doctors I have presented this to do not know what to do with this information but yet I am constantly plagued with the symptoms of my head feeling too heavy for my neck to support, dizziness especially with neck movement,severe heart palpitations, severe tinitus, crunching popping and slipping out feeling in my upper neck. The deep inner muscles in my upper neck also shake and tremor when I nod my head or turn my head from left to right when lying down. I don’t know what to do and have presented my information to various spine doctors and surgeons and don’t seem to be getting any real answers. I must mention that shortly after the accident and for early months following I moved my neck relatively normally and have since develop major loss of range of motion of my neck along with all the crunching and popping which was not there in the beginning.. I feel as if I should be wearing a neck brace 24/7 but I’ve been strongly advised to not do that by the doctors I have seen. Any advice or insight would be beyond greatly appreciated. I have many other tests and reports of my cervical spine I can provide

[Donald Corenman, MD, DC]

#21446

I assume that you had an MRI that included axial images (top-down slices) of the occiput-C1 and C1-2 joints. Make sure the radiologist has read those areas (or has experience reading the upper cervical spine as many radiologists do not have the expertise in this area). Do you have a subluxation that reduces to “normal” (alignment wise) when your head is in neutral position or is the C1-2 level subluxed when you return to neutral?

Normally, degenerative changes noted at C1-2 (“moderate degenerative changes at the anterior atlanto-axial joint”) could mean a number of things. Is this the dens-C1 junction he is talking about (which means nothing) or is this the anterior portion of the C1-2 bilateral articulations?

Don’t beat yourself up about no initial care. You would not have had a diagnosis initially even with a physical examination. You could have injured the alar ligaments or injured the joint surface of C1-2. Either one can develop the issues you note. Crunching and popping are typically related to an irregular wearing of the joint surfaces of occiput C1 or C1-2.

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.

[Pete1221]

#21448

Dr. Yes I have had two upper cervical specific MRI studies with axial imaging. One of them was read by a doctor David who I’m told understands the area very well, the other was read by another radiologist who is versed in the area.

The study that was read by reads.
-Multilevel spondyloaropathy involving the mid and lower cervical disc levels.
– potentiation of several of the key elements of the ligamentous and membranpus static stabilization mechanism of the cervical occipital junction consistent with sequels of hyperextension/flexion hypermobility stress of the cranial vertebral junction
– loss of the normal anatomic relationship of c1 and c2 consistent with Atlanto-axial rotary instability and insufficiency
– asymmetric widening all of the left lateral ADI.
– encroachment of the cerebellar tonsils without high grade chiari.

The second study which was taken over a year later reads
– left alar partial tear
– left transverse ligament intra substance tear
– asymmetric widening of the left lateral ADI. 4mm on left 2mm on right
– more anterior position of the right side of the body of c2 relative to the left with horizontal c1 anterior arch associated with slight degree c1c2 rotation.

I don’t have any more information that goes into detail about the degenerative changes at the anterior atlanto-axial joint. Its frustrating that they do not specify as you stated.

As far as not beating myself up it’s extremely hard not to. This situation has turned my life upside down and inside out. I have not worked for over 10 months as a result. It’s pretty frustrating to know now that if I was evaluated and braced appropriately for a short period time I likely would have healed up just fine.

So the real question is where do I go from here as I am NOT getting any real answers from anyone. Is this something that will just continue to get worse and worse over time. Will I eventually become a surgical candidate. To my understanding upper cervical surgeries are life-altering and devastating to say the least, especially when it comes to craniocervical fusion.

Or is this something that can actually correct itself and get better through time. It’s hard for me to think that way as I am quickly approaching two years of dealing with this and I have feelings and symptoms now that I did not in the beginning, like for instance I now have extreme sharp pain and popping with deep breaths on both sides of my spine right at the cervical thoracic area, this pain never leaves me and I have presented it to several spine doctors and all they can say is get on pain medication.

I also had a digital motion X ray study done which shows a lot of slippage and motion of c1 on C2 with lateral bending(4mm in both directions) and also a lot of movement with flexion and extension of c4 c5 and c6 the worst of which is 5.8mm(c5 on c6).

I am beyond frustrated with all this as I have a wife and a kid to provide for. And expertise or insight and advice would be beyond appreciated.

Thanks

[Pete1221]

#21449

Dr. I forgot to mention that I have become incredibly concerned or scared I would say of moving my neck a certain way or taking a simple slip and fall or a minor fender bender and becoming exponentially worse. The doctors I have seen say I should not be concerned about that but my body tells me otherwise. Do I have levels of damage and instability to a point where I really should be concerned about making them worse inadvertently?

[Donald Corenman, MD, DC]

#21453

First-generally once the alar and transverse ligaments are torn, they do not heal even if placed in a brace for a period of time. Identifying the injury initially would not have changed your course of history.

You have a partial instability of C1-2. The right side subluxes due to transverse and alar ligament incompetency. This will only be made stable with a C1-2 fusion. Yes-50% of rotational motion occurs at this joint but I will assume that you have significant loss of rotation due to pain and the feeling of instability when you rotate your head. Your feeling of “doom” with head motion is concerning as I always think that the patient has the best knowledge of his or her symptoms.

I no longer do occiput-C2 surgeries but if you would like, you can call the office and I will give you a referral name of a surgeon I trust.

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.

[Pete1221]

#21454

Dr. Thanks for getting back to me. I called your office line and left a message about getting that referring doctor you are talking about. Why is it that you do not do upper cervical fusion anymore? So based on the information I presented you feel I am a candidate for a fusion surgery? Do you think there’s a chance I need up through my occiput fused or just c1 c2?

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