Neck injury and MRI results

Hello Dr. Gross,

I'm a white male age 46 and consider myself in excellent shape.

I recently had an accident while using a lat pull down machine. I'm not a heavy gym rat or a a 'body builder', I just use the gym to keep tone and maintain mass. I'm basically slender build 5-11 and weigh about 183

While seated at the lat machine, my knees were secure under the roller pads, I was slightly leaning back and pulling the lat bar down and towards my chest with approximately 175lbs, when without warning,the cable released, causing the bar to smack my chest, while my torso went backwards, almost level, then my head snapped back beyond the 'normal range' I immediately felt a burning sensation and the base of my skull and had a tingling and pain feeling down my right shoulder to mid scapula.  The burning and constant headache feeling lasted about 8 weeks. All the muscles around my neck seem very tender still, but the strong burning sensation has stopped. The MRI results were from Clermont Radiology in Florida.

I'm trying to differentiate the results of the MRI from normal aging to soft tissue injury, herniation etc.

1. Is my herniation or 'bulging disc' most likely from my head snapping backwards, or is it from 'aging' or from the bones pushing my disc gradually over time. The Radiologist mentions 'herniation in several part of his findings. It's my understanding the to have a herniation ,the outer covering has to 'tear' spilling some of the contents, of which causes the 'burning sensation', tingling etc.
'
2. With regard to fore,aft,side 'ligaments..'insufficiency '...is this a result of the tissues being stretched when the head gets snapped back too far? so now, all ligaments are weak, and just need some strength training..etc?

3. what is this?   "Loss of the normal longitudinal collagenous architecture of the anterior dura mater/tectorial membrane, with focal high-grade defect.

4.what is this?  Loss of the normal longitudinal collagenous architecture of the posterior dura mater/ posterior atlanto-occipital membrane (PAOM). High-grade "class III" lesion.  Should lesion be a concern?

Radiologist report summary :

Flexion:
Instability:
Anterolisthesis of C3 on C4, C4 on C5 and C5 on C6 as manifestation of insufficiency of the posterior longitudinal ligament (PLL).

Widening of the posterior disk space heights at the C3-4, C4-5 and C5-6 levels consistent with insufficiency of the posterior longitudinal ligament (PLL).

Widening of the interspinous intervals at the C3-4, C4-5 and C5-6 levels as a manifestation of insufficiency of the capsular and interspinous ligamentous complexes.

Rigidity:
The cervicothoracic discovertebral segments demonstrate paradoxical lordosis to flexion stress.  Paradoxical lordosis is considered a guarding mechanism that can serve as indirect evidence of muscle spasm/soft tissue injury.

Decreased mobility of the C1-2 level, manifested as fixed hyperextension of C1 on C2 throughout range of motion.

Extension:
Instability:
Retrolisthesis of C3 on C4 to extension stress.

Widening of the anterior disk space heights at the C3-4 consistent with insufficiency of the anterior longitudinal ligament (ALL).

Position dependent exacerbation of the disk displacements.

Rigidity:
Relative immobility of the discovertebral segments of the cervicothoracic junction to extension stress.

IMPRESSION:
ALIGNMENT:
Loss of the normal cervical lordosis accompanied by broad based scoliosis.

PATHOANATOMY:
1. Multilevel spondyloarthropathy, with C5-6 right paracentral disc herniation is the dominant feature. Please see above report for additional and pertinent negative findings as well as level by level analysis.

2. Attenuation of several of the key elements of the ligamentous and membranous static stabilization mechanism of the cervico-occipital junction, the constellation of findings consistent with sequela of hyperextension/flexion/hypermobility stress of the craniovertebral junction.

3. Loss of the normal anatomic relationship of C1 and C2, consistent with atlantoaxial rotatory instability/insufficiency.

4. Encroachment by the cerebellar tonsils on the foramen magnum without high-grade Chiari malformation.

*Again, we all age etc..just trying to logically separate my injury when my neck snapped backwards in the gym, from normal aging etc.

Thanks,

Sincerely,

Michael/Tampa

[S. Kaul, MD]

Hi there!

1. The disc herniation could be traumatic or degenerative. It would be difficult to differentiate.
2. The ligament insufficiency could also be a part of degenerative or traumatic process. Yes, physical therapy would be useful for this.
3. The durameter is the outermost covering of the spine and the tectorial membrane is a continuation of one of the spinal ligaments that maintain the stability of the spine. Loss of ‘longitudinal collagenous architecture’ could also be degenerative or traumatic, though in your situation is more likely to be traumatic.
4. The atlanti-occipital membrane is also one of the stabilizing ligaments/ membranes in the neck. A high-grade "class III" lesion may be a matter of concern.
Well, the findings are more likely to be related to trauma than an ageing (aging) related degenerative process at the age of 46, though degeneration could have been a contributing factor. You may like to discuss the report in detail with your orthopedician/ neurologist/ neurosurgeon.
Hope this was useful.

Take care!