Spinal injury. Symptoms: Orthopedic or Neurologist Consults? Or both?

[cammie]

I was injured 9 days ago while assisting to transfer a patient. I have continous pain in the lumbar area of my back. Like forced pressure. Often I have sharp shooting pains that radiate to my hips and down my left leg to the knee area. None past there. Once while waiting to be seen at the closest E.R., on my 2nd visit, my left leg became numb and when I stood up I had to have assistance walking. This occured once after that visit. I am able to stand, walk slowly. I am unable to stand or sit for periods over 10-15 minutes at longest due to increasing pressure & pain felt in my lower back. If I continue either of these activities longer it leads to the shooting sharp pains. As if they are firing one after the other bringing me to tears. During the visit to an orthopedic physician, I was able to slowly get to a supine position, raise the right leg fairly well. But when lifting the left leg caused great pain, sharp and increased pressure. Standing I was able to lean to the right about 65-70 degrees, to the left only about 45 degrees..both resulting in pain, yet worse with the left. No nausea at that time. I say this because I have been asked by each physician I have seen that question.  I was told he suspected torn muscles or torn ligaments from the spine, placed on steroids and talwin for pain. Several hours after the visit I had a strange moderately painful headache and stomach queasiness*. No vomiting. It passed away after a while. Later, after dinner,and taking the new medicines for the first time, I noted another the strange headache again, nausea that ultimately led to copious vomiting. Almost immediately after emptying the contents of my stomach the headache was gone.  These headaches were unlike any I experienced before. Not migraines and not just irritations.

I am an RN, not that that matters in this case. But I know a little. I personally feel I need to see a Neurologist and am becoming more concerned about this headache and nausea I am feeling as I type this.  If you please, could you in some way shed some light on this. I haven't taken anymore of the medicine since the regurgitation episode and my food was prepared as it should have been. Other family members didn't experience this either. Could these S/S be related to the spinal injury? Could this injury be more than just torn muscles & ligaments?

Sincerely in need,
Cammie

[CCF Neuro[P] MD, RPS]

Dear Cyndy:

I think that I would push to see a neurologist.  Sounds like you may have a nerve root problem called a radiculopathy.  However, without examining you I can't tell.  Anyway, I think the neuroloigst would be a better person to see.  Good luck, but rehab is a viable modality to help with your pain.

Sincerely,

CCF Neuro MD

[CYNDY]

On the evening of January 23rd I woke up with shooting pain down my right arm and side.  This was followed by a prickly tingling feeling and numbness.  I also had severe pain eminating from my lower back and between my shoulder blades.  When I sneeze or cough the pain is worse in all areas.  I had been doing some very strenuous lifting at work over the weekend, especially earlier that Sunday because of an upcoming inventory at our store.  Anyway, I called off of work on Monday and expained to my boss that I really wasn't sure at this point what was wrong.  When I called the doctor's office they said it could possibly have been a mild stroke or an injury to my back.  After an examination by my doctor he sent me for an MRI stating that he believed I had a herniated disc in my cervical spine.  I went for the MRI and it came back with the following results:

Moderate anterior and posterior degenerative spurring is seen from C3 down to C7.  There is narrowing of the C3-C4 and C4-C5 intervertebral spaces.  At the C5-C6 level, there is a minimal central and left paracentral disc herniation slightly impinging upon the anterior wall of the thecal sac and the left nerve root at this level.  There is a mild broad based disc bulging at the C6-C7 level.  Impression:  Minimal central and left paracentral disc hernaition at the C5-C6 level.  Mild broad based disc bulging at the C6-C7 level.  Minimal to moderate degenerative osteoarthritic changes from C3 down to C7.

I am suffering from extreme pain on a daily basis.  I am unable to take pain medications due to my stomach.  I cannot sleep.  My most comfortable position is sitting reclined.  I am suffering from muscle spasms followed by muscle cramping in my arms and legs.  Shooting pains, which feel like someone injecting icy antibiotics into my veins, mostly down my left arm and occasionally down my right arm and left leg.  There is now a constant tingling and numbness in my arms and fingers. Occassional tingling and numbness in my legs.  I had a full right knee replacement over a year ago which now hurts incredibly.  There is also pain in eminating from my right hip and lower lumbard area which may or may not be related.  There is weakness in my arms and legs and holding my head up causes increased pain everywhere else.  When I move my head I can feel and hear popping crackling sounds.  I get extremely rough and disturbing headaches.  There is always a slight headache eminating from the bottom of my neck up.  Burning and pulsating.

Workman's comp sent me to an orthopedic surgeon for an exam and he attributed my pain to muscle strain and soft tissue damage.  His recommendation was 3 months of physical therapy they back to work.  When I asked him about the herniation and disc problems, he wrote them off saying they were minor and that most of my problems in that area where normal degenative problems due to my age.  I am 43 years old as of January 15th.  He did address any of my other pains but wrote them off as strained muscles.  I have been in a auto accident and have had just strained muscles before and this is nothing like that.  I have been on celebrex for my knee since my surgery and have undergone several months of physical therapy.  When I told the doctor I was already taking an anti-inflamatory medicine, celebrex, he acted surprised, but still insisted that all I needed, at the most, was 3 months of physical therapy to put things right.  I have an appointment with a neurologist next Tuesday, that my original doctor had originally set up for a week earlier but workman's comp had cancelled it saying it was manditory for me to see their doctor first and they rescheduled my neurology appt for me, but I don't know if they are going to pay for me to see this doctor or not.  However, everyone else that I have spoke to and all of the research that I have done suggests that I really need to see a neurologist not an orthopedic.  I can't stand much more of this pain.  I fear I may do something drastic.  What do you think?  There is more involved with workman's comp but I don't want to address all of that here.  You can e-mail me at ***@**** and I can give you my phone number or get yours for further information.  I need help!

Sincerely,
Cyndy Roper

[CCF Neuro[P] MD, RPS]

Dear Tonya:

I would see your neurologist, without an examination I am alittle uncertain of why the back pain.  The normal MRI is a good thing.  It may be that you strained some muscles and they just haven't had a chance to heal with all the movement of your back in everyday life.  It could also be that the nerve injury is slight enough not to be seen on MRI.  I would see your neurologist and have a good neurological exam.

Sincerely,

CCF Neuro MD

[Tonya on Tuesday Feb.15/2000]

I hurt my lower back lifting about 5 months ago . Why would it be affecting my upper back also especially if i do anything streuous i suffer later for it.I've had a closed in mri done it came back normal.Can you give me any suggestions please .

[CCF Neuro[P] MD, RPS]

Dear Cathy:

Sorry your in pain.  I can't tell you about why 2 MRI's would give different results because MRI will only show anatomy.  The reader of the films differ and that may be the source of the differences.  Your description of the MRI indicate that changes have occured in the lumbar part of your spine.  These would not give you neck pain.  The radiation of pain down your leg might come from the L5 area of spondylosis, especially if the cord was compromised.  I would ask your neurologist or neurosurgeon to go over the MRI films with you.  I have never heard of "rids", so I can't make a comment on that finding.

Sincerely,

CCF Neuro MD

[Cathy]

I  have been in two car accidents and I have severe low back pain that radiates down my left leg all the way to the end of my toes. I have had two MIR's and both showed different results. I am so much in pain and the doctor told me that the MIR's are not always accurret. I am starting to believe that there is nothing that can be done about my pain. I would like to know why I am having this much pain and my last 5-view exray said, impression: Bilateral L5 spondylosis without spondylolisthesis. Also, it states that, There are rudimentary rids at T12.  What exactly does that mean and could it have anything to do with my neck? My neck also hurts very badly and radiates down my left arm to my finger tips.  I am a mess and no one can tell me why. I was very active now I can't sit, stand, or walk for very long about 10-15 min. at a time but it is worse when I sit. (5-min) What is wrong and what do I do?
                     in a lot of pain,
                            Cathy

[CCF Neuro[P] MD, RPS]

Dear Ann:

The symptoms you describe are usually the reason given for having decompression procedure of a Chiari I malformation in the first place.  To be having them status post surgery might indicate instability of the surgical procedure.  I would call your neurosurgeon and tell him/her about the symptoms.

Sincerely,

CCF Neuro MD

[Brainstem Compression..Craniectomy 8 mos]

Hi CCF,  I have a quick question regarding episodes transient like attacks of numb left side of face,numb tongue, difficult swallowing and slurred speech?  I have Arnold-CHiari Malformation type 1 decompressed over 8 mos ago, then 2 mos ago symptoms started coming back ..but now having constant neck and back pain with headaches.  Then within the last week developed episodes like TIAS has described above lasting a short while with breathing distress.  I keep having these attacks daily. They are very frightening...can this be related to my ACM or could it be another source?

Thanks, Ann

[CCF Neuro[P] MD, RPS]

Dear Cammie:

Sorry to hear about your back problems.  I think you need to see a neurologist.  I think what your symptoms and your head are telling you is that you may have injured your spine.  It sounds like your having radicular pain, especially when you tell me it radiates down you leg (sounds very sciatic nerve-like).  Does the radiating pain happen when you cough or sneeze?  Anyway, you need to see a neurologist (also neurosurgeon) and get an MRI of your lumbar spine.  Do not get an open MRI but the usual closed MRI.  Your vomiting is likely medication induced.

Let us know what happens.

Sincerely,

CCF Neuro MD