Traumatic Spine Injuries, suffered in motor vehicle collision
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.