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Traumatic Spine Injuries, suffered in motor vehicle collision

Started by jpa1033 on 05/17/2010 4:40am

I am frustrated, in constant pain, seeking answers:
I am 37 yrs old, with no prior history of back/neck pain or any spinal injury. I am a law enforcement officer working a "Class 4 Arduous" position (patrol).

2 years ago, I was rear-ended, while stopped, by a DUI driver traveling 65-75mph. I had immediate pain and stiffness in my neck, with intense tingling in my left facial cheek. Within 2 hours of the collision, I developed severe pain in my mid neck, lower neck, between my shoulder blades, and in my low back. I also developed severe intense tingling radiating into my lower face (cheeks, lips, chin), down my arms to my fingers (along C8 dermatome), and down my legs to my toes (L5 dermatome).

The initial treating physician of my HMO diagnosed me with muscle spasms from whiplash. On my persistence, he referred me for C and L spine MRIs two days following the collision. The cervical MRI showed an annular tear of the C4/5, mild reversal of cervical lordosis, and diffuse disc osteophyte complex flattening thecal sac w/o central stenosis. The lumbar MRI showed an annular tear of the L4/5 with minimal circumferential annular bulge flattening thecal sac.

My HMO physician referred me to physical therapy and chiropractic care, and placed me off work.

My symptoms continued, with developing constant burning, intermittent pain spikes, and muscle drop/weakness in my arms and legs. The paresthesia (tingling), and neck and back pain continued, and a month later I was referred for a T-Spine MRI. The MRI showed mild bulging at C6/7, C7/T1, T3/4, T4/5, with pulsation artifacts w/in thecal sac.

I was referred to a neurologist for an EMG study, which showed no peripheral nerve damage. I saw a spine surgeon who told me he could not explain my continued pain and paresthesia, and told me that there are lots of people with "black discs" and that all should get better. No further testing or treatment was prescribed.

I treated with chiropractic care for six weeks following the collision, but stopped after experiencing no relief, and actually had increased leg/foot pain, with several instances of immediate stabbing heel pain following neck manipulation.

I treated with physical therapy (exercise,TENS,ultrasound,massage), for the next 4 months, but experienced no relief of my symptoms. My pain and paresthesia increased with any physical activity. I returned to work four months after the collision, on light duty/admin duty status.

A year later, still experiencing severe neck and back pain, with continued intense paresthesia in my arms and legs, I was referred to a neurologist with my HMO, who ordered a new complete set of MRIs, which showed same previous injuries. He told me he could not explain my pain or tingling, and referred me to a neurosurgeon.

The neurosurgeon refused to discuss my collision and injuries as a whole, and would discuss only one level of injury. We chose to discuss the low back. He stated he saw evidence of possible arachnoiditis, but would not diagnose or document this, as it was "not his job to diagnose my condition, only to determine whether or not I was a surgical candidate". He stated he did not feel I was a surgical candidate. He prescribed a Medrol 6 day dose pack, for treatment of "inflammation". While taking the Medrol, I experienced increased burning in my arms and legs. I also developed a small painful lump under my left nipple (this continued to grow to over an inch in diameter, and was surgically removed this past March).

I consulted with another HMO neurosurgeon, and discussed my cervical injuries. He stated the reversal of cervical lordosis indicated cervical ligament damage, but again I heard the line that "it was not his job to diagnose this, only to determine surgical candidacy". He also stated that he did not feel I was a surgical candidate, and referred me back to my neurologist.

My neurologist again told me he had no explanation for my continued pain and symptoms. He referred my to Pain Management. The PM physician told me she could not treat me, since I did not have a diagnosis. She did prescribe Lyrica, which I took for a short time, but discontinued due to side effects (mental fogging) and lack of effect on my symptoms.

I sought a second opinion with another HMO neurologist. After reviewing the MRIs and EMG, he also told me he could not explain my continued symptoms. He then told me (verbatim) "All you need is a positive mental attitude, since that will do more for you than any doctor can."

I tried another neurosurgeon, who had the same response, but prescribed an epidural steroid injection in my low back. Since I had been researching my injuries, I asked him if he would order a dynamic MRI (showing flexion/extension of spine). He told me that "if there were such a thing" that he didn't think it would show anything different than the static supine MRI. He performed the ESI, and after a severe initial reaction that sent me to ER 3 days following, I still had no relief. I had an increase in the burning pain in my legs for several weeks following.

All of this took a year and a half, and I was at my wit's end, totally exhausted with the constant run-around without answers or relief. I contacted my attorney and sought an opinion outside my HMO.

At this point, I still had constant neck, mid and low back pain, constant tingling and burning in my arms and legs. All increased with minimal physical exertion. The low back pain and leg pain increase with twisting/bending motiions.

I consulted with an outside neurosurgeon, who immediately told me to disregard all that I had been told by my HMO. He did not read the MRI text reports, and instead reviewed each MRI himself. He ordered a dynamic positional lumbar MRI, and a DMX video fluoroscopy of my neck. The MRI showed increased herniation and bulging at the L4/5 during extension.

The video flouroscopy showed: lateral translation greater than 3.5mm left/right lateral bending, indicating laxity of left and right alar ligaments; Anterior translation of C2 and C3 during flexion indicating posterior ligamentous laxity; Posterior translation of C2, C3, C4, and C5 during extension indicating anterior ligamentous laxity.

The outside neurosurgeon's recommendation was fusion of my C4/5, and an microdiscectomy of my L4/5, with possible need for disc replacement of the L4/5, should the discectomy fail to resolve the pain and leg symptoms.

Unfortunately, I was unable to proceed with this doctor, since my injuries had been picked up by my department under CA worker's comp (which resolved after a two year dispute and suit), and he did not treat under work comp. The combination of vehicle insurances was not enough to cover any surgery, so I was forced to seek the care of an approved work comp doctor.

I am currently treating with a reputable doctor at SCOI, however work comp continues to delay progress. The doctor ordered discograms of my cervical and lumbar spine. Work comp has so far denied the discograms, claiming controversial application/results.

The other outside surgeon told me that a discogram was unnecesary, and wished to proceed with surgery.

I would like as much input as anyone can provide, I know this is a lengthy post, but I am exhausted from the 2 year run-around, and the conflicting answers. I have heard so many differing opinions, I dont know what is accurate. I just want my life and career back.

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14 Responses

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Hi - I hear that you are having cervical and lumbar MRI - and note that the doctor is not sending you for thoracic MRI. I mention this because of the symptoms you are experiencing and that they are very much like the ones I had pre-surgery and again now post-surgery. Just a thought. Mine was ignored by my doctor for two years until I saw a very brilliant orthopaedic surgeon whom found a huge disc bulge pushing onto my spinal cord at t7/8 area. I too can not tolerate medication and they barely take the pain or neurological symtoms away - at least with just anti-inflammatories I have the pain and I have a clear mind, and its not 'foggy'. The thoracic spine also caused me the leg trouble, arm trouble etc as well as chest trouble, almost identical to yours. May be worth just asking your medical team.

Best wishes

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Wow that sounds terrible. You have been through so much. It sounds like the fact that you are going through workmans comp. seems to be a problem all in it's self. My mother is a nurse and was injured on the job and between her insurance and workmans comp she is going through something similar.They treat you differently.
All I can tell you is I was in pain for many years before I decided to try pain management. It is definatly helping me. My pain management doctor gave me an MRI before he would even see me. He has helped me more then any other doctor that I had been to before. He refered me to the right doctors and surgeons.
Before that I had seen nuerologists and they told me the same as you. They said I was not a candidate for surgury.
But now I found the different opinions and the meds and steroid injections were very helpful for me.
Have you tried the injections?
well good luck and feel better

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Hi there,
So sorry to hear of your ongoing battle for ANSWERS! I too have a work comp, and had auto accident and have had cervical and lumbar surgery with success although with my work comp injury, added new problems to both areas. HMO, well they are paid to see alot and do NOTHING as far as I am concerned. Its a drs job to diagnose so thats ridiculous the pain dr couldn't treat you without a diagnosis. I have heard good things about scoi, but with the ongoing delay with your treatment due to workers comp, do you have an attorney? Attorneys can help with getting things authorized, depends on attorney. Pain management is beneficial but really depends on what injuries are and where you go. Did your doctors ever do any tests to make sure their were no other underlying health issues that may also be working against you? My family in law enforcement and I know how demanding it is and how officers like yourself feel about your work - its your life and not being able to feel at your BEST and not getting answers has got to be tough! I would ask your doctor for an I.F. unit and hot and cold therapy. And get into pool therapy and do all you can build your core, this is what I did post operatively and I worked a week later. Now with new injuries, I am doing all I can to strengthen my core, light exercise and also think positively. THeir are actual studies on the EMOTIONAL AFFECTS OF PAIN. Its not bs seriously. Dont let injury, pain or work comp get you upset as that can lead to additional pain. I also heard of a neurosurgeon in Bev Hills who helps patients like you and he primarily helps those in CHRONIC PAIN without doing spine surgery. He is supposed to be really good, his name is Jacob Chadokewicz and he does see work comp patients, perhaps check him out. He is very nice. The more opinions the better and my friend Catherine knows him really well and he doesnt care about insurance he cares for getting patient help and freedom from pain, its at least worth it to get an opinion. Hope you get better soon and work comp stops messing around. Keep the faith! God Bless.

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I have tried all the meds: neurontin, lyrica, ultram, vicodin, naproxen, ambien, flexeril, tylenol, motrin, medrol, and ended up needing prilosec due to the upset stomach.

I have had no relief with any of the "pain" meds, and no relief and unpleasant side effects with the neuro meds. Since I am still working, I cannot take anything that will alter me, since I have to drive to and from, and need to be coherent (working in our 911 dispatch center) during work.

I had increased radicular pain with the steroids, medrol and the epidural injection, as well as the unwanted growth (over 1 inch dia, surgically removed).

I am glad to finally be treating with doctors who have said that surgery is the most likely next step, since this confirms my research over the past two years.

Anyone have success with discectomies and fusions? My goals are to be able to return to my active life, without fear of continued progressing injury from even menial tasks. (As I have now, since even the slightest tasks increase the pain.)

I have tried all conservative approaches, and have found nothing that helps.

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Hi Again! I have had two fusions. I had a 3-level cervical fusion and 1 level lumbar. Having surgery is a big step, their are several good surgeons out their and if you are still with SCOI I have heard great things about them! Has anyone discussed disc replacement for you? I am not a doctor so not every candidate is a good one for that but from what I heard if your a young and fairly healthy individual the success of them are truly remarkable. I have seen SEVERAL GREAT OUTCOMES from spine surgery, but it depends on YOU and the YOUR SURGEON for the MOST PART. What I did for rehab and I have told many others is, get into the POOL and walk it, jog it, swim and even I got in the jacuzzi. Within a month I was slowly getting back into cardio with the eliptical / precor machines. Dont do too much and be careful but if you have determination and seriously get in the pool and build up your CORE you will DO GREAT! Life is too short to live in the amount of pain you seem to be living in, and I know many including family members in your line of work, so I know how important it is for you to do your work and get back to it! I hope this helps and have phenomenal outcomes! All the best, GOD BLESS!

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Thanks for your encouragement, it does give me hope to hear that surgery was a success. I am looking forward to being able to rebuild strength and recondition my muscles, since now any exertion just leads to increased lasting pain. Definitely looking forward to when activity will be constructive again.

The back pain is bad, but what I find most limiting is the radiating leg and arm pain and tingling. I've had a few episodes where one of my legs has given out, always following prolonged exertion (the most recent was during our move, and although I did not lift or move anything heavy, just being on my feet all day was enough).

The doc at SCOI said he wants to do the discograms to confirm, but as long as they do, then the fusion of the C4/5 and L4/5 discectomy would be his recommended course of action.

Now if we can only get WorkComp to cooperate....we have appealed their denial of the discograms, and are waiting to hear...

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I realized that I left out treatment that I tried.... While I am looking for advice and answers myself, I also hope that my experiences can help someone who may just be in the beginning stages of a similar injury.

4-5 months after my injuries, a doctor I was treating with prescribed a session of acupuncture. I have always been skeptical of "eastern medicine" type treatments, but am will to try most things once.

I saw a chiropractor who did electro-acupuncture. This involved placing the acupuncture needles in my back, and attaching TENS type electrodes. The session felt like a more intense TENS session, which actually works temporarily to distract from the pain. I felt good until about a 1/2 hour afterward, when the TENS numbing wore off. The back pain increased, and the radiating pain shot through the roof. My right hand began shaking uncontrollably, which continued, taking several days to decrease and stop. Thought I had contracted Parkinson's...WONT DO THAT AGAIN.

When I told the doc, he said it was likely an overstimulation caused from the TENS. So he sent me to another acupuncture therapist. (I have since used a personal TENS unit, which does provide very temporary distraction relief of the back pain. It does not help with the arm/leg symptoms.)

I tried again, since this was the traditional type acupuncture, w/o the TENS. I left with new hand aching pain, from where the needles were placed just below the webbing between thumb and forefinger. This lasted over a week. Decided not to do that again either.

Again for anyone who is just beginning, these are my experiences with "conservative" and "alternative" treatment modalities. My experiences, for me, have confirmed my research, that my injuries are mechanical in nature, and until surgically corrected, will continue to produce symptoms.

Despite what my HMO told me, simply having a "Positive Mental Attitude" won't cure it, and after having taken anti-inflammatory meds for over a year and a half, and having a steroid injection, my problems lie deeper than mere inflammation. I'm not a doctor, but I can clearly see the injuries on the MRIs, both tears and bulging of the discs is quite apparent.

So, my advice is to avoid HMO treatment, and if possible seek treatment with known private specialists. I'll update my status as I go...

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Hi their,
SO sorry to hear of your work comp issues, who is your carrier? Is it through the County of the city?
Which dr at SCOI are you seeing? Moldawer? Grossman? My injuries taught me alot and I have been fortunate to meet lots of people within the healthcare arena due in part because of it. i have heard so many people like yourself suffer, my Cervical Fusion was C3-C6 so C4-C5 will be minimal recovery and certainly the discectomy is NOTHING compared to fusion and I would definately wait for DISCOGRAM. This procedure, although painful but short, it allows the dr to determine which disc is causing the pain your complaining of. When they do the procedure what they are hoping to do is, Replicate exactly what you are complaining of so they can then tell your surgeon exactly WHAT is the CAUSE of the pain. I had lots of spasming after both procedures, dont be shocked. Go to PT and go swimming and do your stretches and keep a positive attitude, it will make a huge difference! Its hard to be so happy and optimistic with your pain and frustration with work comp but if anything get MAD at the system and give you the determination to turn your pain and life around and help others as I have. God uses us all to help others, when your going through it you are so frustrated but it gives me so much joy knowing my pain and suffering has been able to help others. If you have any other questions, etc let me know I will be more than happy to help!

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Work comp is Tristar Group, through LA County. I am currently treating with Dr Moldawer at SCOI, with a second consult scheduled this week with Dr. Dillin at Kerlan & Jobe. Only heard great things about both, just wish I could have seen them 2 years ago. I am also trying to schedule a consultation with Dr.Todd Lanman, but he is not currently in the County's NPN (approved network), so Tristar denied that. His office told me that he is in the process of being accepted, and should be within the next couple of months.

On the whole, I have always been positive, and still maintain that. Just laugh that it is all following Murphy's textbook laws...it took us 2 years to gain the work comp coverage (due to a gray area of coverage, though supported on my side by several case law decisions. In fact they denied coverage until 2 days before the jury trial was scheduled to start, then "Ok, we'll pick it up".), so I really don't expect them to authorize everything overnight....though that would be nice!

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I know who tristar is, who is your adjuster? I have not met or know Dr Dillin. I know Dr Moldauer he works with alot of police officers, he is a great person, physician and very conservative. For Dr Lanman, funny you said that I know him too. He helped out a patient I was introduced to and saved her life, he has great hands! You should check out Dr Darren Bergey and Dr Sunny Uppal. ALthough they are NOT in LA, they are EXCELLENT and they are on the tristar panel and i have seen them go to bat with other patients to get things authorized. Do you have attorney? if so, who is it? Its a battle, but even I have had to help others go against insurance companies. I met this 30 yr old who been denied benefits, treatment and didnt receive any income for over 3 yrs. He had a medical-legal review done which said and mandates by law for spine surgery. He was married with 2 little kids and couldnt work. I felt so bad for him, I helped him get in with a doctor, went with him to many of his appointments and when he was admitted to ER for pain, stayed with him and his family and the next day got a hold of VP Ins company and the Nurse Case Manager and had his surgery authorized. I guess you can call me the PATIENT ADVOCATE. Many ask me why I help as I dont get paid for it, but I believe in KARMA and heck I didnt have any help in my situation and WE ARE ALL VICTIMS in work comp, unless you have been their no one can relate, - so you can thank GOD as truly it gives me great joy helping people. Who is your adjuster at TriStar? I have a friend who has a few friends their, maybe I can help out.
Keep the faith, I assure you one day you will be saying Im going into surgery, :)

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Well, had my appointment with Dr. Dillin of Kerlan-Jobe, and he too recommended the CT Discograms.

Found out the SCOI contacted Tristar to check the status of the second request, and my adjuster, conveniently, said he never received it when it was faxed directly to him 3 weeks ago. Another 3 weeks wasted.

But at least now we have two independent doctors asking for the same tests, so perhaps this will spur them on a bit quicker.....though probably not.

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hi, adjusters always say that. And Ive heard from insurance companies and people I know on that side that the LAW States that IF the dr requesting tx sends with proof of copy for request of any treatment if the ins company DOES NOT RESPOND WITHIN 5 days than its considered to be auto approval. However, their are MANY DRS and SCOI and Kerlan Jobe to be in part that get ALOT of business from insurance companies so they may not push this envelope. It doesnt mean they are not good doctors or are right in what they are recommending but they dont want to piss them off, Furthermore, if you see approved doctors like these you are more likely to get things authorized at some point it really depends on how much your doctor really tries to get things moving with carrier. For some reason they (ins co) dont want to authorize or pay for anything these days!! Nightmare. I have pain in both arms now from elbows down due to my fall at work a few years ago. I hope its just pinched nerve in my elbows and not also my neck but I know what you mean about pain. Nerve pain is the worst!!
Have you seen a pain dr recently? Perhaps you can see a different one and at least get some relief until you have your procedure. Overall did you like Dr Dillin? i have never met him or know much about him? I love to hear patients feedback as thats really important next to how good they are.

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Well, work comp denied the Dr's request for the CT Discograms a second time. The Dr wrote a termination of treatment, since work comp would not authorize his diagnostic tests.

So now, it appears that my next option is to have a hearing with a work comp judge, and see if he will override work comp. Waiting for my attorney to get back to me with a proposed scheduled date.

And so I wait....some more....

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jpa,
These postings are a little old now so I am not going to write too much unless I hear back from you that you are still posting here. I went through a similar situation as you (rear ended and multiple level injuries). I wonder if we might be able to help one another. I am interested in the fluroscopy type test you talked about that shows flexion/extension injuries. I may have a ligament related injury in my cervical spine as part of my problems. I did have surgery 1/13/11 on my thoracic spine (endoscopic discectomy) that I could relate to you. Lots of MD run-arounds and miscommunications too. Lumbar issues too. Bottom line is that lawyers are needed in these situations. email me if easier: homenet@frontiernet.net . I am in NY state and so our insurance issues are probably a little different. We have no-fault here. Basicly means that the other driver paid to fix / replace my car (it was totalled) and my insurance pays my medical bills ($75,000 coverage) and then it goes to regular medical insurance. I blew a bundle on the surgery...about $50, 000 I think. so just post again and then i'll know you are still active on this board.

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