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in reply to: Feels like a Broken Neck #4570
You have sent three images- one CT of skull, one lateral view of the head and one of an axial CT of the cervical spine. I notice a fracture of the lamina of that vertebra. I cannot determine what could be the problem based upon limited images and symptom knowledge. Please contact my office at 970 476-1100 to send all your images.
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.in reply to: Feels like a Broken Neck #4563The initial impact or the first accident would have pushed you towards the passenger side. The rebound sounds like you suffered a secondary impact against the window and door. The second impact might have aggravated the previous injury.
The hip labrum tear is not my speciality. The neck most likely had preexisting degenerative changes that were aggravated by the first accident. Suffering from pain along the entire spine can have many sources. You could have injured multiple areas of the spine, developed somatization syndrome or have pain generated from the neck that refers down the spine.
I appreciate you sending an AP x-ray of the spine but that by itself won’t reveal the source of problems. DIagnosis needs to be made with a good history and physical examination, evaluation of x-rays and MRI or CT myelogram and possibly other specialized tests.
I do think you need to see a spine specialist to sort out your problems.
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.in reply to: pain after spinal stenosis op. #4561By your description, it sound like you had a bilateral decompression of the L5-S1 level. The description of the cyst removal at left S1 leads me to believe that you have degenerative facets at that level. Cysts can occur from other structures but 95% of cysts are ganglion cysts and are associated with degenerative facets. To carry the association further, degenerative facets are associated with degenerative spondylolysthesis (see that topic discussed in the web site under “conditions”).
There are four possibilities that could have occurred to cause continued pain. One is that simply the nerves are still inflamed from surgery and over time, they will calm down and the pain will go away. The second is that there is a hematoma (a collection of blood) that is causing compression and again, over a period of time, it will resorb and the pain will recede. The third is that there could be a recurrent ganglion or herniation and that may need to be diagnosed.
The forth possibility is foraminal stenosis or lateral recess stenosis that may be part of the initial pathology. If your pain occurs with standing and walking and disappears with sitting or bending forward, the last possibility is more likely. Check the section on foraminal stenosis to see if that might fit with some symptoms.
The x-rays may give some clue. The x-rays need to be taken in the standing position and hopefully, x-rays were also taken in the bending forward and backward positions (flexion and extension). If there is a slip of L5 on S1, this would mean a degenerative spondylolysthesis is present. Decompression surgery (which is the surgery you underwent) can occasionally aggravate this condition but understand that decompression surgery by itself is generally indicated and OK for this condition.
Let me know what you find out.
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.By your description of symptoms, it sounds like you had developed myelopathy (see section on myelopathy in this web site). The doctors diagnosed the compression of your spinal cord was from “C1,C2,C3” and performed surgery to decompress the cord from the front of your neck. It sounds like they placed a titanium plate or cage. Your symptoms did not change and one year later, you underwent another operation with an ACDF (see chapter on website for that description).Your symptoms have not changed since both operations.
Myelopathy is caused by compression of the spinal cord. Surgery is designed to reduce or eliminate the compression on the cord. If there is cord damage already- surgery will hopefully prevent further progression of cord damage. The chance of the spinal cord healing is up to mother nature and not very common. This is why it is most important to diagnose the disorder earlier than later.
By your report, it may be that you had the first surgery, developed a pseudoarthrosis (the bone graft did not heal in) and needed a second surgery as the compression reoccurred. I can not tell you if the second surgery was successful, but if you have an MRI or CT scan performed after the second surgery, I would be happy to take a look at it. Call 970 476-1100 and ask to talk to one of my nurses.
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.It is difficult to injure an opposite side nerve during surgery as it is not in the operative field and literally about 3/4 inch away. When under the microscope, that distance is the equivalent of about two miles away in the non-medical world. I guess that injury could happen but very unlikely.
Pain in the opposite side nerve could occur under three circumstances. One is a phenomenon called cross-over pain. The nerves in the opposite sides of the body eventually cross over in the spinal cord (you remember from high school that the left side of the brain takes care of the right side of the body). The cross-over or decussation allows the nerve to come in contact with each other. It is theorized that there is “cross-talk” between the nerves at this point.
The second possibility is that there is a small hematoma (collection of blood) in the canal that is causing temporary compression or even inflammation. If this is the case, most of the time this hematoma will resorb and not be a problem in the future.
The third but unlikely possibility is that there was a fragment of disc material that migrated across the canal or the discectomy caused some collapse of the disc height and there is some compression of the opposite nerve. This should also become quiet over time.
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.You mention three symptoms- paresthesias (pins and needles), muscle twitches and pain in both legs. Let’s discuss what can happen to a nerve root with a disc herniation and go over each symptom separately.
When a nerve is compressed, as from a herniated disc, damage can occur to the nerve that is permanent. Remember that the nerve is really just a very long cell with the membrane of the cell conducting the signal. Pressure on these membranes from a disc herniation can stop the signal in terms of numbness or stimulate the signal in terms of pain sensation. If the nerve membrane was damaged by the herniation/compression- permanent pain and numbness can occur by blocking the signal or allowing the pain signal to be generated by a leaky membrane.
Most herniations do not cause permanent symptoms but some do. Symptoms of “pins and needles” can take up to six months to disappear after the discectomy and occasionally can be permanent. Most individuals can ignore these paresthesias as they subside. Nerves can continue to be “persnickety” and sensitive for up to two years.
Pain can continue if damage to the nerve occurred. Most times, the pain recedes over 6 months but again, some individuals can have chronic pain from nerve injury. If the pain does not improve and a new MRI reveals no compression (must look for other causes such as foraminal stenosis), the the patient has a chronic radiculopathy and needs pain management services.
Muscle twitching could be from an injury to the motor nerve. This would manifest as weakness (the foot is undependable or “flops when walking” or more difficulty with climbing or descending stairs. If you notice weakness or the physical examination reveals weakness, an EMG test can reveal if recovery is possible.
Hope this helps.
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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