Discussion:
Questions on Potential Treatments Related To Back/Nerve Injury
(too old to reply)
Jay R.
2006-03-28 05:32:33 UTC
Permalink
I had a car accident (rear-ended while stopped at a light) about a
year ago, and suffered a slipped disk, among other things. My doctor
is recommending a number of potential treatments, ranging from
Prolotherapy to a Cervical Nerve Block Foramina, possibly up to
surgery, if necessary. He is also recommending against some
treatments, such as chiropractic. While I respect medical advice, I
also like to hear from other patients who have been in similar
situations. I also have some other questions related to my injury.
While I am seeing an orthopedist I trust, and also a neurologist who
seems very good, sometimes feedback from those who have experienced a
problem can be as helpful as that from doctors. (However, any doctors
who read this are welcome to chime in as well!)

Details of my situation follow: As indicated, I was stopped at a red
light, when I was rear-ended by some guy, traveling somewhere between
25 to 40 miles per hour (that's a wild guess, based on damage to the
car, plus how hard the hit seemed to feel at the time). I suffered a
very nasty whiplash injury -- I should have gone to the hospital right
away, but not having experience with these things, I though the pain
would go away in a few days. (Hah!)

I did have an X-ray about a week later, and there was no broken bone
in the neck. I started on physical therapy, which I kept doing for
six months or longer. I also had an MRI. The main result was: "The
C6-C7 level shows an 8 x 3 x 7 mm (LR x AP x SI) left paracentral disc
extrusion with moderate stenosis of the left side of the central canal
impinging but not compressing the side of the cervical cord."

Almost a year after the accident, the worst of the neck/shoulder pain
and tightness has subsided. However, I continue to have the following
symptoms:
1. A chronic, moderate pain in my upper back/lower neck, right around
the C6/C7 region. It gets significantly worse as the day wears on,
but fortunately when I lie down the pain is less, so at least I can
sleep. The pain is usually minor in the morning, but again gets worse
and worse as they day goes on.
2. Difficulty lifting objects, including fairly light objects.
Definitely a problem for shopping and doing laundry, plus some
household tasks.
3. Some ongoing limitation of neck motion. Not nearly as bad as
right after the accident, but in particular I still have limitations
on how far I can look up.
4. A moderate numbness or tingling in the palms of both hands.
5. In the right hand, some muscle problems. Occasionally I get
spasms where the hand grips closed, and it's hard to open. Also,
trouble with certain kinds of gripping motions (such as opening pill
containers). And a general, ongoing muscular ache, as if the muscles
are always being slightly stimulated, even when they should be
relaxed.
6. I also have a very slight numbness at times on the bottom soles of
my feet, possibly related to some other findings on the MRI, but that
symptom is mild enough that I'm not even going to worry about it for
now.
7. Minor shocks -- hitting potholes, for instance -- cause relapses
of varying degrees, in that the neck pain becomes worse again for
several days or even weeks.

Both my orthopedist and the neurologist say the symptoms in my hands
are definitely related to the C6/C7 disk. I was puzzled that symptoms
are worse in my right hand, when the disk is supposedly distended to
the left. The neurologist, however, says the disk can slip around
over time. They also tell me that the chronic pain in my upper
back/lower neck (in the rear) is also a result of the C6/C7 disk.

I am done with physical therapy, other than home exercises, which I
continue to do. I also continue to take Ibuprofen to relieve pain and
inflammation, though I'm not sure how much that is helping at this
point. I also take a muscle relaxant at night.

I did see a chiropractor for an eval. He said that under the
circumstances, he would not do chiropractic work on the neck, only on
my lumbar region. He did feel that since my head sits a bit forward
on my shoulders -- a long-standing condition, pre-accident and
pre-symptoms -- he wanted to give me some exercises to help move my
neck back. He was also going to try applying traction (which I
already had with the physical therapy) to give the disk room to move
back into place.

The neurologist was okay with trying the chiropractor's treatment, but
he felt it was not very likely to relieve my symptoms. My orthopedist
was more direct, saying he is afraid it could actually put the disk
more out of joint, and create worse symptoms.

The orthopedist has suggested the following path:

1. First, prolotherapy, to try and strengthen the ligaments in my
back.
2. If that doesn't work, he wants me to try a cervical nerve block
procedure to relieve the pressure on the C6/C7 nerve roots extending
through the foraminum.
3. If that fails, he wants me to consider major surgery. The doctors
would slice through the front of my neck, remove the bad disk, and
fuse the C6/C7 vertebra.

As you can imagine, I have a few questions at this point! The
questions are fairly open-ended, so feel free to add any additional
comments you deem appropriate.

1. Has anyone in a similar situation tried chiropractic work, and
found that it either helped or did more harm?
2. Similarly, the prolotherapy -- did it help? Are there any risks
associated with it?
3. Similarly, the cervical nerve block -- help, harm, or no
difference? My orthopedist says he thinks the risks are very limited,
but I'd like to hear "user" perspectives.
4. Finally, anything anyone can tell me about experiences with
surgery. In particular...

I was surprised when the orthopedist said they would remove the disk
altogether. My impressions was that they usually just trimmed the
part of the disk that was sticking out. Also, what kinds of
limitations in head motion would I expect after having those C6-C7
vertebra fused, if that's what happens? I mean, I'm not planning to
do Judo or yoga or gymnastics, so I don't need exceptional mobility.
But I want to know ahead of time if I would experience noticeable
impact on common movements -- turning the head while driving, looking
up or down for any purpose (work, reading, talking to people), just
the normal stuff you do with your head in the course of a day.

Any and all feedback and advice would be much appreciated. Has anyone
has symptoms similar to mine, and found that it eventually resolved on
its own, but just took a couple of years?

Thanks much for all replies!!

JS
OneTiredGrandma
2006-03-28 16:17:15 UTC
Permalink
Jay,

I had 2 herniated disks at C6-C7. My neurosurgeon said he would be
going in from the back of the neck to do a diskectomy. He actually
butchered the area, cut a nerve path completely in half and damaged
another nerve path. The pain I live with on a daily basis cannot be
described. Surgery works for some people, some of us are left
completely debilitated by surgery. What was suppose to be a diskectomy
ended up being a diskectomy, laminectomy,and forminatomy. I'm sure
there are neurosurgeons who can complete this type of surgery without
damaging their patients to the extent my surgeon left me damaged. Get
references and check with your state's medical board before going ahead
with surgery....

Not sure what type of nerve block you are suggesting, there are a few
types. I've had several ESI's, Epidural Steroid Injections with no
relief from the pain. I've also had several Stellate Ganglion Nerve
Blocks, with no relief from the pain. The SGNB's are barbaric and
extremely painful. Again, some people are helped with the ESI's and
some people are helped with the SGNB's.

I still have trouble turning my neck, cannot lift my left arm very
high, have pain with each and every movement. This isn't just stub
your toe type of pain. It is the most debilitating pain I have ever
experienced. I would rather give birth every day, than live with the
pain I live with that this neurosurgeon caused. My left arm is
definitely the arm affected, but any movement of the right arm can
cause pain in the left. I guess it's the muscles attached to the left
side.

After trying physical therapy, with 2 therapists, they both would not
work with me due to the nerve damage. They did give me a couple of
simple exercises to do at home to try and strengthen the left arm, but
would not do any actual rigorous PT.

This has changed my entire life.....every aspect is changed. I can't
even stand to brush my teeth any more. The pressure at the C6-C7 level
causes so much pain I can only stand for short durations. Nerve pain
is very unique, unlike other types of pain, nerve pain is constant,
unrelenting and so intense I actually asked to have my left arm,
amputated 5 years ago, thinking that would relieve my pain. Of course
the medical establkishment would not do this. I have very limited use
of my left arm and hand due to the pain involved in using it for
anything.

Hope this helps you in some strange way......not everyone ends up like
this. There are success stories out there. I'm just not one of them.
Keep us updated on your decision and your outcome. Hopefully you will
get some more information, with a better outcome than I have. :)
Post by Jay R.
I had a car accident (rear-ended while stopped at a light) about a
year ago, and suffered a slipped disk, among other things. My doctor
is recommending a number of potential treatments, ranging from
Prolotherapy to a Cervical Nerve Block Foramina, possibly up to
surgery, if necessary. He is also recommending against some
treatments, such as chiropractic. While I respect medical advice, I
also like to hear from other patients who have been in similar
situations. I also have some other questions related to my injury.
While I am seeing an orthopedist I trust, and also a neurologist who
seems very good, sometimes feedback from those who have experienced a
problem can be as helpful as that from doctors. (However, any doctors
who read this are welcome to chime in as well!)
Details of my situation follow: As indicated, I was stopped at a red
light, when I was rear-ended by some guy, traveling somewhere between
25 to 40 miles per hour (that's a wild guess, based on damage to the
car, plus how hard the hit seemed to feel at the time). I suffered a
very nasty whiplash injury -- I should have gone to the hospital right
away, but not having experience with these things, I though the pain
would go away in a few days. (Hah!)
I did have an X-ray about a week later, and there was no broken bone
in the neck. I started on physical therapy, which I kept doing for
six months or longer. I also had an MRI. The main result was: "The
C6-C7 level shows an 8 x 3 x 7 mm (LR x AP x SI) left paracentral disc
extrusion with moderate stenosis of the left side of the central canal
impinging but not compressing the side of the cervical cord."
Almost a year after the accident, the worst of the neck/shoulder pain
and tightness has subsided. However, I continue to have the following
1. A chronic, moderate pain in my upper back/lower neck, right around
the C6/C7 region. It gets significantly worse as the day wears on,
but fortunately when I lie down the pain is less, so at least I can
sleep. The pain is usually minor in the morning, but again gets worse
and worse as they day goes on.
2. Difficulty lifting objects, including fairly light objects.
Definitely a problem for shopping and doing laundry, plus some
household tasks.
3. Some ongoing limitation of neck motion. Not nearly as bad as
right after the accident, but in particular I still have limitations
on how far I can look up.
4. A moderate numbness or tingling in the palms of both hands.
5. In the right hand, some muscle problems. Occasionally I get
spasms where the hand grips closed, and it's hard to open. Also,
trouble with certain kinds of gripping motions (such as opening pill
containers). And a general, ongoing muscular ache, as if the muscles
are always being slightly stimulated, even when they should be
relaxed.
6. I also have a very slight numbness at times on the bottom soles of
my feet, possibly related to some other findings on the MRI, but that
symptom is mild enough that I'm not even going to worry about it for
now.
7. Minor shocks -- hitting potholes, for instance -- cause relapses
of varying degrees, in that the neck pain becomes worse again for
several days or even weeks.
Both my orthopedist and the neurologist say the symptoms in my hands
are definitely related to the C6/C7 disk. I was puzzled that symptoms
are worse in my right hand, when the disk is supposedly distended to
the left. The neurologist, however, says the disk can slip around
over time. They also tell me that the chronic pain in my upper
back/lower neck (in the rear) is also a result of the C6/C7 disk.
I am done with physical therapy, other than home exercises, which I
continue to do. I also continue to take Ibuprofen to relieve pain and
inflammation, though I'm not sure how much that is helping at this
point. I also take a muscle relaxant at night.
I did see a chiropractor for an eval. He said that under the
circumstances, he would not do chiropractic work on the neck, only on
my lumbar region. He did feel that since my head sits a bit forward
on my shoulders -- a long-standing condition, pre-accident and
pre-symptoms -- he wanted to give me some exercises to help move my
neck back. He was also going to try applying traction (which I
already had with the physical therapy) to give the disk room to move
back into place.
The neurologist was okay with trying the chiropractor's treatment, but
he felt it was not very likely to relieve my symptoms. My orthopedist
was more direct, saying he is afraid it could actually put the disk
more out of joint, and create worse symptoms.
1. First, prolotherapy, to try and strengthen the ligaments in my
back.
2. If that doesn't work, he wants me to try a cervical nerve block
procedure to relieve the pressure on the C6/C7 nerve roots extending
through the foraminum.
3. If that fails, he wants me to consider major surgery. The doctors
would slice through the front of my neck, remove the bad disk, and
fuse the C6/C7 vertebra.
As you can imagine, I have a few questions at this point! The
questions are fairly open-ended, so feel free to add any additional
comments you deem appropriate.
1. Has anyone in a similar situation tried chiropractic work, and
found that it either helped or did more harm?
2. Similarly, the prolotherapy -- did it help? Are there any risks
associated with it?
3. Similarly, the cervical nerve block -- help, harm, or no
difference? My orthopedist says he thinks the risks are very limited,
but I'd like to hear "user" perspectives.
4. Finally, anything anyone can tell me about experiences with
surgery. In particular...
I was surprised when the orthopedist said they would remove the disk
altogether. My impressions was that they usually just trimmed the
part of the disk that was sticking out. Also, what kinds of
limitations in head motion would I expect after having those C6-C7
vertebra fused, if that's what happens? I mean, I'm not planning to
do Judo or yoga or gymnastics, so I don't need exceptional mobility.
But I want to know ahead of time if I would experience noticeable
impact on common movements -- turning the head while driving, looking
up or down for any purpose (work, reading, talking to people), just
the normal stuff you do with your head in the course of a day.
Any and all feedback and advice would be much appreciated. Has anyone
has symptoms similar to mine, and found that it eventually resolved on
its own, but just took a couple of years?
Thanks much for all replies!!
JS
Pete
2006-03-28 23:41:27 UTC
Permalink
Post by OneTiredGrandma
Jay,
I had 2 herniated disks at C6-C7. My neurosurgeon said he would be
going in from the back of the neck to do a diskectomy. He actually
butchered the area, cut a nerve path completely in half and damaged
another nerve path.
How do you know that. I'm sure he didn't tell you that.


The pain I live with on a daily basis cannot be
Post by OneTiredGrandma
described. Surgery works for some people, some of us are left
completely debilitated by surgery. What was suppose to be a
diskectomy ended up being a diskectomy, laminectomy,and forminatomy.
I'm sure there are neurosurgeons who can complete this type of
surgery without damaging their patients to the extent my surgeon left
me damaged. Get references and check with your state's medical board
before going ahead with surgery....
Not sure what type of nerve block you are suggesting, there are a few
types. I've had several ESI's, Epidural Steroid Injections with no
relief from the pain. I've also had several Stellate Ganglion Nerve
Blocks, with no relief from the pain. The SGNB's are barbaric and
extremely painful. Again, some people are helped with the ESI's and
some people are helped with the SGNB's.
I still have trouble turning my neck, cannot lift my left arm very
high, have pain with each and every movement. This isn't just stub
your toe type of pain. It is the most debilitating pain I have ever
experienced. I would rather give birth every day, than live with the
pain I live with that this neurosurgeon caused. My left arm is
definitely the arm affected, but any movement of the right arm can
cause pain in the left. I guess it's the muscles attached to the left
side.
After trying physical therapy, with 2 therapists, they both would not
work with me due to the nerve damage. They did give me a couple of
simple exercises to do at home to try and strengthen the left arm, but
would not do any actual rigorous PT.
This has changed my entire life.....every aspect is changed. I can't
even stand to brush my teeth any more. The pressure at the C6-C7
level causes so much pain I can only stand for short durations.
Nerve pain is very unique, unlike other types of pain, nerve pain is
constant, unrelenting and so intense I actually asked to have my left
arm, amputated 5 years ago, thinking that would relieve my pain. Of
course the medical establkishment would not do this. I have very
limited use of my left arm and hand due to the pain involved in using
it for anything.
Hope this helps you in some strange way......not everyone ends up like
this. There are success stories out there. I'm just not one of them.
Keep us updated on your decision and your outcome. Hopefully you will
get some more information, with a better outcome than I have. :)
Post by Jay R.
I had a car accident (rear-ended while stopped at a light) about a
year ago, and suffered a slipped disk, among other things. My doctor
is recommending a number of potential treatments, ranging from
Prolotherapy to a Cervical Nerve Block Foramina, possibly up to
surgery, if necessary. He is also recommending against some
treatments, such as chiropractic. While I respect medical advice, I
also like to hear from other patients who have been in similar
situations. I also have some other questions related to my injury.
While I am seeing an orthopedist I trust, and also a neurologist who
seems very good, sometimes feedback from those who have experienced a
problem can be as helpful as that from doctors. (However, any
doctors who read this are welcome to chime in as well!)
Details of my situation follow: As indicated, I was stopped at a red
light, when I was rear-ended by some guy, traveling somewhere between
25 to 40 miles per hour (that's a wild guess, based on damage to the
car, plus how hard the hit seemed to feel at the time). I suffered a
very nasty whiplash injury -- I should have gone to the hospital
right away, but not having experience with these things, I though
the pain would go away in a few days. (Hah!)
I did have an X-ray about a week later, and there was no broken bone
in the neck. I started on physical therapy, which I kept doing for
six months or longer. I also had an MRI. The main result was: "The
C6-C7 level shows an 8 x 3 x 7 mm (LR x AP x SI) left paracentral
disc extrusion with moderate stenosis of the left side of the
central canal impinging but not compressing the side of the cervical
cord."
Almost a year after the accident, the worst of the neck/shoulder pain
and tightness has subsided. However, I continue to have the
1. A chronic, moderate pain in my upper back/lower neck, right
around the C6/C7 region. It gets significantly worse as the day
wears on, but fortunately when I lie down the pain is less, so at
least I can sleep. The pain is usually minor in the morning, but
again gets worse and worse as they day goes on.
2. Difficulty lifting objects, including fairly light objects.
Definitely a problem for shopping and doing laundry, plus some
household tasks.
3. Some ongoing limitation of neck motion. Not nearly as bad as
right after the accident, but in particular I still have limitations
on how far I can look up.
4. A moderate numbness or tingling in the palms of both hands.
5. In the right hand, some muscle problems. Occasionally I get
spasms where the hand grips closed, and it's hard to open. Also,
trouble with certain kinds of gripping motions (such as opening pill
containers). And a general, ongoing muscular ache, as if the muscles
are always being slightly stimulated, even when they should be
relaxed.
6. I also have a very slight numbness at times on the bottom soles
of my feet, possibly related to some other findings on the MRI, but
that symptom is mild enough that I'm not even going to worry about
it for now.
7. Minor shocks -- hitting potholes, for instance -- cause relapses
of varying degrees, in that the neck pain becomes worse again for
several days or even weeks.
Both my orthopedist and the neurologist say the symptoms in my hands
are definitely related to the C6/C7 disk. I was puzzled that
symptoms are worse in my right hand, when the disk is supposedly
distended to the left. The neurologist, however, says the disk can
slip around over time. They also tell me that the chronic pain in
my upper back/lower neck (in the rear) is also a result of the C6/C7
disk.
I am done with physical therapy, other than home exercises, which I
continue to do. I also continue to take Ibuprofen to relieve pain
and inflammation, though I'm not sure how much that is helping at
this point. I also take a muscle relaxant at night.
I did see a chiropractor for an eval. He said that under the
circumstances, he would not do chiropractic work on the neck, only on
my lumbar region. He did feel that since my head sits a bit forward
on my shoulders -- a long-standing condition, pre-accident and
pre-symptoms -- he wanted to give me some exercises to help move my
neck back. He was also going to try applying traction (which I
already had with the physical therapy) to give the disk room to move
back into place.
The neurologist was okay with trying the chiropractor's treatment,
but he felt it was not very likely to relieve my symptoms. My
orthopedist was more direct, saying he is afraid it could actually
put the disk more out of joint, and create worse symptoms.
1. First, prolotherapy, to try and strengthen the ligaments in my
back.
2. If that doesn't work, he wants me to try a cervical nerve block
procedure to relieve the pressure on the C6/C7 nerve roots extending
through the foraminum.
3. If that fails, he wants me to consider major surgery. The
doctors would slice through the front of my neck, remove the bad
disk, and fuse the C6/C7 vertebra.
As you can imagine, I have a few questions at this point! The
questions are fairly open-ended, so feel free to add any additional
comments you deem appropriate.
1. Has anyone in a similar situation tried chiropractic work, and
found that it either helped or did more harm?
2. Similarly, the prolotherapy -- did it help? Are there any risks
associated with it?
3. Similarly, the cervical nerve block -- help, harm, or no
difference? My orthopedist says he thinks the risks are very
limited, but I'd like to hear "user" perspectives.
4. Finally, anything anyone can tell me about experiences with
surgery. In particular...
I was surprised when the orthopedist said they would remove the disk
altogether. My impressions was that they usually just trimmed the
part of the disk that was sticking out. Also, what kinds of
limitations in head motion would I expect after having those C6-C7
vertebra fused, if that's what happens? I mean, I'm not planning to
do Judo or yoga or gymnastics, so I don't need exceptional mobility.
But I want to know ahead of time if I would experience noticeable
impact on common movements -- turning the head while driving, looking
up or down for any purpose (work, reading, talking to people), just
the normal stuff you do with your head in the course of a day.
Any and all feedback and advice would be much appreciated. Has
anyone has symptoms similar to mine, and found that it eventually
resolved on its own, but just took a couple of years?
Thanks much for all replies!!
JS
KathyIL
2006-03-28 16:30:40 UTC
Permalink
Hi Jay,

I too, was rear ended at a high rate of speed 4 1/2 years ago. In my
case, I was sitting at a red light when a women who was arguing with
her teenage daughter came along and rear ended me at 40-50 mph causing
$15,000.00 damage to my Ford Explorer. She hit me so hard that she
even broke the baffle in the gas tank.

Lucky me, I was again rear ended this past August by a very large
commercial Freightliner van.

It took me until this past fall to get accurately diagnosed. I went to
Mayo in Rochester and saw a neurologist and their top neurosurgeon.

To make a long story short, first of all, I was born with a smaller
than normal spinal canal (congenital spinal stenosis).

I now have two very prominent disks at the c5-6 and c6-7 level causing
severe compression of my cord. There are also problems at the c2-3
level and a small bulge that has an anular tear in my thoracic spine at
the t8-9 level. The surgeon said that the thoracic disk will not get
any worse. I certainly hope he is right as this is where they have to
crack your ribs to get at it.

The good news is that while I have what they termed "severe spinal cord
compression", there is not any spinal cord LESION yet. A lesion means
damage and is very serious (this is how you become paralyzed).

Since my original accident was 4 1/2 years ago, I have a lot of
arthritic changes causing further compression on the canal. I was told
that further arthritic changes will definately cause cord compromise.
Mayo and my local doctor are now monitoring me very closely for the
impending myelopathy (cord damage).

While the doctors at Mayo are very nervous, since they did not find a
lesion on the MRI, nor any deficit on the neurological exam, nor any
abnormal finding on the EMG, they, and I, feel that the risks of the
surgery are too great to do it at this time. Of course, I am at very
high risk of complete paralysis with even a minor bump. I cannot see a
chiropractor, ride on any amusement park ride or water slide, cannot do
weight bearing exercises, etc. The thing I miss most is practicing
with my son's high school football team (just kidding).

Several things about your post bother me. First of all, how old are
you? I am 45 now and was 40 when the original accident happened.

You do not say when the MRI was done. If it was done right after the
accident, you should probably have another one done and it should be of
your entire spine (cervical, thoracic and lumbar). Did you have an EMG
or SSEP? Did you have a complete neurological exam and did they find
any deficit?

The fact that you are having problems opening your hand is pretty
scary. This in itself is something they should have found on the
neurological exam. The problems lifting objects is also not normal. I
have many of the same symptoms as you, but not these two.

Have you considered seeing a neurosurgeon instead of the orthopedist?
If I were you, I would definately do this.

Please remember that my condition has been progressive and will
continue to progress due to the aging process and the fact that my
spine was severly weakened during the first accident. My spondylosis
(neck arthritis) is moving along at a much higher rate of speed than
normal.

Good luck with everything. Please be careful about rushing into this
surgery and please keep in mind that the artificial disks are expected
to be approved by the FDA this year for a single level cervical surgery
such as what it sounds like you might eventually need. I don't know
where you are at, but I have the name of a world renowned neurosurgeon
in Chicago who specializes in artificial disk surgery. I, myself, am
hoping that my impending myelopathy may hold off until this is approved
for multi level surgery. Right now, I am not a candidate, but who
knows in 5 to 10 years I might be. There are many advantages to using
artificial disks, including no plates and rods, no collar for 8 weeks,
no further degeneration below the level of fusion, no bone graft (which
is usually taken from your hip and causes many problems at the donor
site), etc.

Take care,

Kathy
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