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Neurology (Expert Forum)
spinal instability, herniated, facet joint syn....which came first?
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spinal instability, herniated, facet joint syn....which came first?
by Trish, Aug 28, 2000 12:00AM
Thank you so much for providing this site...throughout my ordeal it has educated me and kept me "hanging in there". I finally got through after 5 months of trying everyday and now (lol) I'm not sure where to begin.
I am a 33 year old female.
In Jan of 99 I had an cspine xray revealing cervical lordosis between c4 and c7. vertabral body ht and min were normal. the c5-6 disc space was minimally narrowed. Apophyseal joint hypertrophy suggestively narrows the right c2-3 neural foramen. This test was after an airplane seat collapsed. I felt ok after a few weeks of spasms in neck.
6 months later I went skydiving (trying to isolate a specific event) and my neck started bothering me soon after and the muscles would spasm severely. I had a few episodes where the suboccipital area would get numb swell and cause alot of pain. The underside of my left side of my tounge was always swollen. I would get terrible inside ear pain also ear clicking and intermittent TMJ that seems to be associated with the bone shifting. I should mention I also had alot of ENT probs (2 cysts in sinus-frequent irrigations)just after the initial episodes.
The spasming and pulling to the left increased in frequency and severity to the point where I could not pull my neck far enough over to my right and back to relieve the pulling from the opposite side. Loud popping and snapping could be felt and heard. By december 99 I could no longer stand it and went to a chiro. She said I had "brain stem compromise" and would adjust my atlas accordingly. It helped the a little but relief was short lived.
In march of this year I was rear ended in an auto accident (approx 30mph). The xray revealed minimal subluxation of c4 on c5. All my symptoms were worse and still concentrated on my left side but the right suboccipital also swelled. I would also get "rib end" in my sternum area by my heart. I went for 2 months of PT when one night I had shooting pain and lost feeling in left arm. The selling in the back of my head increased in severity and frequency.
MRI reveals a left paramedian and lateral extruded disc hern, which results in mild to moderate spinal stenosis on the left. There is also moderate to severe left foraminal narrowing with possible impingement of the the exiting c6 nerve root. There is no definite evidence of cord compression. There is diffusely low signal within the bone marrow of cspine T1 weighted images. This represents age appropriate hematopoietic marrow.
The radiculopathy stopped after manual traction 2 weeks later.
Old symptoms worsened and New symptoms appeared. I have cloudy thinking, fatige, memory problems. My thorasic area is mimicing the old neck prob. My body is pulling down to the left and inward and I have to relieve it by arching and pulling to the right and backward. Also a pain from my back under my left arm to my heart area started as well as an area by my left shoulder blade that spasms and seems to tighten muscles that affect my breathing. My heart rate also goes very fast at times. If that area is rubbed and I "shift my neck,,,,a noise, and a release seems to rid the problem immediately and I can breath easy again. When the two suboccip areas are rubbed and I shift my neck the swelling spasming and pain usually subsides too although a few times it has antagonized the symptoms.
Where I am now: I continued PT and received injections Aug 7..cerv ster/epidu of c6 nerve root, the left side of my facet joints c2-c6. The severe pulling has stopped on the left side but the contsant "bone shifting in my neck" has not although it happens a little less. Also, Aug 21 facet joints steroid injections of C1&C2 (I think...they said they went up a level.) She says I have facet joint syndrome. My ear pain and clicking immediately went away after the shots. Also my tounge has not swelled since (these things have been that way for a year and a half. The tmj is only there after a "bone shift" and disappears when it shifts again. My left suboccipital is not as swollen anymore. My right is swollen. I have the thorasic problem/breathing/heartrate and this shifting taking place in my neck seems to control everything.
From what I have researched I am convinced that I have atlanto-axial instability and/or a missed fracture of facet joint or instability of some sort.
1.) I would appreciate your opinion/speculation as to what condition started all this.and the order of events...the herniation, the facets or a ligament (other?)I do not want to end up with surgery on my disc if it is something else that caused this.
2.) What exact tests should I have done?
3.) What could happen if I have atlanto/axial or one of the above things and it remains undetected or untreated?
4.) Any comments, suggestions, or warnings.
I hope I covered it all. Thank you sooooooo much. I can't tell you how much this means to me. My life for the last year has been hell. I can barely go anywhere or do anything anymore. The shots have helped but it's not over. Where to go from here?
I am a 33 year old female.
In Jan of 99 I had an cspine xray revealing cervical lordosis between c4 and c7. vertabral body ht and min were normal. the c5-6 disc space was minimally narrowed. Apophyseal joint hypertrophy suggestively narrows the right c2-3 neural foramen. This test was after an airplane seat collapsed. I felt ok after a few weeks of spasms in neck.
6 months later I went skydiving (trying to isolate a specific event) and my neck started bothering me soon after and the muscles would spasm severely. I had a few episodes where the suboccipital area would get numb swell and cause alot of pain. The underside of my left side of my tounge was always swollen. I would get terrible inside ear pain also ear clicking and intermittent TMJ that seems to be associated with the bone shifting. I should mention I also had alot of ENT probs (2 cysts in sinus-frequent irrigations)just after the initial episodes.
The spasming and pulling to the left increased in frequency and severity to the point where I could not pull my neck far enough over to my right and back to relieve the pulling from the opposite side. Loud popping and snapping could be felt and heard. By december 99 I could no longer stand it and went to a chiro. She said I had "brain stem compromise" and would adjust my atlas accordingly. It helped the a little but relief was short lived.
In march of this year I was rear ended in an auto accident (approx 30mph). The xray revealed minimal subluxation of c4 on c5. All my symptoms were worse and still concentrated on my left side but the right suboccipital also swelled. I would also get "rib end" in my sternum area by my heart. I went for 2 months of PT when one night I had shooting pain and lost feeling in left arm. The selling in the back of my head increased in severity and frequency.
MRI reveals a left paramedian and lateral extruded disc hern, which results in mild to moderate spinal stenosis on the left. There is also moderate to severe left foraminal narrowing with possible impingement of the the exiting c6 nerve root. There is no definite evidence of cord compression. There is diffusely low signal within the bone marrow of cspine T1 weighted images. This represents age appropriate hematopoietic marrow.
The radiculopathy stopped after manual traction 2 weeks later.
Old symptoms worsened and New symptoms appeared. I have cloudy thinking, fatige, memory problems. My thorasic area is mimicing the old neck prob. My body is pulling down to the left and inward and I have to relieve it by arching and pulling to the right and backward. Also a pain from my back under my left arm to my heart area started as well as an area by my left shoulder blade that spasms and seems to tighten muscles that affect my breathing. My heart rate also goes very fast at times. If that area is rubbed and I "shift my neck,,,,a noise, and a release seems to rid the problem immediately and I can breath easy again. When the two suboccip areas are rubbed and I shift my neck the swelling spasming and pain usually subsides too although a few times it has antagonized the symptoms.
Where I am now: I continued PT and received injections Aug 7..cerv ster/epidu of c6 nerve root, the left side of my facet joints c2-c6. The severe pulling has stopped on the left side but the contsant "bone shifting in my neck" has not although it happens a little less. Also, Aug 21 facet joints steroid injections of C1&C2 (I think...they said they went up a level.) She says I have facet joint syndrome. My ear pain and clicking immediately went away after the shots. Also my tounge has not swelled since (these things have been that way for a year and a half. The tmj is only there after a "bone shift" and disappears when it shifts again. My left suboccipital is not as swollen anymore. My right is swollen. I have the thorasic problem/breathing/heartrate and this shifting taking place in my neck seems to control everything.
From what I have researched I am convinced that I have atlanto-axial instability and/or a missed fracture of facet joint or instability of some sort.
1.) I would appreciate your opinion/speculation as to what condition started all this.and the order of events...the herniation, the facets or a ligament (other?)I do not want to end up with surgery on my disc if it is something else that caused this.
2.) What exact tests should I have done?
3.) What could happen if I have atlanto/axial or one of the above things and it remains undetected or untreated?
4.) Any comments, suggestions, or warnings.
I hope I covered it all. Thank you sooooooo much. I can't tell you how much this means to me. My life for the last year has been hell. I can barely go anywhere or do anything anymore. The shots have helped but it's not over. Where to go from here?
Doctor's Answer
by CCF Neuro[P] MD, RPS, Aug 28, 2000 12:00AM
Dear Trish:
Sorry to hear about your symptoms. It is difficult to tell you much without examining you and seeing the MRIs, although your descriptions are very nice. First, the left side, vagus nerve does not control the heart rate. So, if your lesion is contributing to your heart racing, then the right side must be involved. I think it might be an idea to see if your heart rate is really speeding up, or is this a perceived speeding up. A tachycardia can be a real medical problem and should be addressed by a cardiologist. Maybe a holter for 24-48 hours to see if you have paroxsymal tachycardia.
If one can get by not having surgery, it is perfered. I would check with the rehab specialist and see what the concensus might be concerning surgery versus continued rehap. It sounds like many of your symptoms are due to the left sided foramen stenosis. The problem here is that after surgery, the physiological immune response often will produce what the surgery relieved-canal stenosis. There comes a point when surgery is often necessary, but this decision must come from the neurological exam, MRI, and patient feelings about the pain. Instability of C1 and C2 is not common, but aittle laxity is seen frequently and clinical judgement is needed as to whether surgery is required, again it is exam and neuroimaging related.
One needs to find a neurosurgeon/neurologist/rehab team that you feel comfortable with and confident in. Based on the neurological exam, neuroimaging studies, rehab progression, a decision can be made. Often, second opinions are helpful.
About what caused your problem, I can't tell you. Since the initial study showed lordosis, I would imagine whatever the etiology occurred before the first film. But the event, is unknown to me.
I am sorry I am not much help.
Sincerely,
CCF Neuro MD
Sorry to hear about your symptoms. It is difficult to tell you much without examining you and seeing the MRIs, although your descriptions are very nice. First, the left side, vagus nerve does not control the heart rate. So, if your lesion is contributing to your heart racing, then the right side must be involved. I think it might be an idea to see if your heart rate is really speeding up, or is this a perceived speeding up. A tachycardia can be a real medical problem and should be addressed by a cardiologist. Maybe a holter for 24-48 hours to see if you have paroxsymal tachycardia.
If one can get by not having surgery, it is perfered. I would check with the rehab specialist and see what the concensus might be concerning surgery versus continued rehap. It sounds like many of your symptoms are due to the left sided foramen stenosis. The problem here is that after surgery, the physiological immune response often will produce what the surgery relieved-canal stenosis. There comes a point when surgery is often necessary, but this decision must come from the neurological exam, MRI, and patient feelings about the pain. Instability of C1 and C2 is not common, but aittle laxity is seen frequently and clinical judgement is needed as to whether surgery is required, again it is exam and neuroimaging related.
One needs to find a neurosurgeon/neurologist/rehab team that you feel comfortable with and confident in. Based on the neurological exam, neuroimaging studies, rehab progression, a decision can be made. Often, second opinions are helpful.
About what caused your problem, I can't tell you. Since the initial study showed lordosis, I would imagine whatever the etiology occurred before the first film. But the event, is unknown to me.
I am sorry I am not much help.
Sincerely,
CCF Neuro MD
The last injections to the C1-C2 were also done on my right side. Since then the scm muscle and the back muscles have been spasming on my right side as well as increasing of the suboccipital swelling. I'm also getting that hard ball type feeling on the right behind my earlobe. This just started after the recent injections. I never had these symptoms like this on the right. I am very concerned. I don't want to go through what I had to go through on the left. Thank you so much for helping!!!
Quite a ordeal your going through, sorry to hear it's not getting better yet. I am curious about the extent of spinal adjusting your chiro was performing. Was it throughout the cervical spine or only the C1 area? From your initial post, it sounds as though you had a loss of cervical curve, which would have been aggravated by the whiplash. A loss of curve can in many cases lead to severe muscle spasm as well as degeneration of the cervical discs over time. The spasms tighten around the nerves leading to many of the symptoms you state. If your chiro is only interested in upper cervical adjusting, I suggest locating a DC that will adjust the total cervical spine and spend the time needed to acheive the results competent chiro care can provide. Good luck.