Back and neck injury

**ludakris9** · 09-20-2005, 06:40 PM

My sister was in a car wreck and messed her neck and back up and Her c6 and c7 disks. She nows has a ten pound limit for life. She has had 2 years physical thearphy, steroid injections, been to many doctors. She was given the choice by a surgen suurgery or live with the pain. Thee surgeon said in my opinion I would live with the pain because you are young and surgery could make things worst. She choose the 10 pound limit. she also isn't allowed to sit, stand, or walk for more than 4 hours a day. Thay had her on lower tabs and muscle relaxers for 1 and half years. Anyone have any opinions on anything she can do to get her back and neck feeling better and raise her weight limit???

***Doc.Sust*** · 09-21-2005, 01:37 PM

the disc herniations sound very severe!!! i know you said she has tried physical therapy, how about chiropractic??has she ever had traction applied to her neck? how about spinal manipulations to the cervical area?surgery is always the last option, but in this case it may be her only hope. discs do not get better they are a permanent injury, the onlything that can be done to relieve tha pain may be surgery. the limitations she has and being on painkillers for that long of a time offer her a poor quality of life. no one should have to go through this.it is possible that surgey inthis case may be this best answer. please give me alist of all the conservative treatments she has tried so far, i may have a few suggestions if she hasn't given them a shot yet.

***Doc.Sust*** · 09-21-2005, 02:13 PM

IDET, or thermal anuloplasty is the introduction of a special wire placed through a needle that enters into the disk. The purpose of that is to alter the protein that makes up the disk fiber; in so doing, it thickens, shrinks, when it's heated. This is pretty much the same application that the sports doctors use when they shrink and thicken the capsules of the shoulder for people who dislocate this joint. It also destroys the tiny nerve fibers that take pain messages from the outside of the pulpy substance of the disk, which is called anulus fibrosis. Treatment is minimally invasive. It's done with the patient awake with intravenous sedation, and this is the safety part of the procedure, so that if something bad was happening, the temperature probe can be turned off to minimize harm. It's done under fluoroscopy and the patient is sent home within 30 to 40 minutes with a band aid on his / her back. There are specific instructions as far as physical activity that must be adhered to. The effects of IDET can be immediate, intermediate, or longer term in coming. The patient may notice complete or substantial loss of pain that was present before the procedure. Typically it takes about six weeks after the procedure for improvement to begin. The improvement can continue for as long as one year. In other words, we've seen patients in whom we felt that the procedure had not been successful at four and six months come back at a year, and are doing really very well.

Let's talk percentages. The percentage number of patients reporting benefit from this procedure in a highly selected group, and the technical problems associated with it, but assume the doctor knows what he's doing from the standpoint of diagnosis and treatment, that percentage is 70 to 72 percent. It is not any more than that at this time. Some people might think that's not good. The fact of the matter is I believe that it's very good because, as this caller indicated, the only other option left is to stay with the pain you have, or have a spinal fusion. That is a big undertaking.

The last part of her question was, what happens in the future. The answer is, I don't know. Nor do the people who have devised this procedure. The reason I say that is that the longest time at this point, and we have been responsible for some of the research for this product, has not exceeded two to three years follow up. In that time, we have not, and I want to emphasize NOT seen an adverse effect. That doesn't mean that can't come at five, seven or ten years. It comes down to treatment options. If you take the disk out to do an anterior fusion, then the disk is gone forever. If you simply try to alleviate the pain with the IDET procedure, then other treatment options may come available as we increase the science of treating these disorders. One of the options is that we're doing at the Texas Instutute, one of five in the US, we implanted artificial disks. The purpose was to not do the spinal fusion. Once you fuse a segment, that segment becomes stiff and the segment above or below becomes stressed and will, with time, deteriorate. The artificial disk, like the knee or hip, allows that joint to continue to move and therefore spare the other segments. Personally, I would not recommend a spinal fusion in a young person if there are other treatment options. Only if the patient does not fit protocol for IDET procedure would I suggest that a fusion be considered.
Taken from Dr. Rosenbaum, MD

now has she tried this procedure? was it an option?

***Doc.Sust*** · 09-21-2005, 02:14 PM

i also know of another hybrid therapist on the board. let me see if he can help as well.

**ludakris9** · 09-21-2005, 02:18 PM

Yes she has been to the chirpractor. Yes, she has had the traction applied to her neck.Yes she has had spinal manipulations done to cervical area. They said that the steroid injections to spine would take away swelling and help discs get better. She had three shots and it didn't change at all from one mri to the second one 1 and half years later. She didn't relize how much pain she was in until she quit taking the pain pills. She had became addicted to them and it was hard for her to quit taking them. Some days she can't even get out of bed because it hurts so bad. She had a physical compasity test done and that is where she got her weight limit of 10 pounds. She is also only allowed to bend, squat, reach above head ect. so many times a day. She use to lift weights all the time she could bench 200 pounds and leg press almost 500 pound not maxed out. It has been hard for her to go from be strong to being weak. It has taken away her job oppurtinites and everything. To make a long story short she was between her car door and her car squatting down to untangle her seatbelt and a old man ran is car into her car door and sent her flying into her car with the impact.

***Doc.Sust*** · 09-21-2005, 02:19 PM

accupuncture???

***Doc.Sust*** · 09-21-2005, 02:20 PM

has she seen a pain management specialist?neurologist?

**ludakris9** · 09-21-2005, 02:26 PM

Originally Posted by Doc.Sust

IDET, or thermal anuloplasty is the introduction of a special wire placed through a needle that enters into the disk. The purpose of that is to alter the protein that makes up the disk fiber; in so doing, it thickens, shrinks, when it's heated. This is pretty much the same application that the sports doctors use when they shrink and thicken the capsules of the shoulder for people who dislocate this joint. It also destroys the tiny nerve fibers that take pain messages from the outside of the pulpy substance of the disk, which is called anulus fibrosis. Treatment is minimally invasive. It's done with the patient awake with intravenous sedation, and this is the safety part of the procedure, so that if something bad was happening, the temperature probe can be turned off to minimize harm. It's done under fluoroscopy and the patient is sent home within 30 to 40 minutes with a band aid on his / her back. There are specific instructions as far as physical activity that must be adhered to. The effects of IDET can be immediate, intermediate, or longer term in coming. The patient may notice complete or substantial loss of pain that was present before the procedure. Typically it takes about six weeks after the procedure for improvement to begin. The improvement can continue for as long as one year. In other words, we've seen patients in whom we felt that the procedure had not been successful at four and six months come back at a year, and are doing really very well.

Let's talk percentages. The percentage number of patients reporting benefit from this procedure in a highly selected group, and the technical problems associated with it, but assume the doctor knows what he's doing from the standpoint of diagnosis and treatment, that percentage is 70 to 72 percent. It is not any more than that at this time. Some people might think that's not good. The fact of the matter is I believe that it's very good because, as this caller indicated, the only other option left is to stay with the pain you have, or have a spinal fusion. That is a big undertaking.

The last part of her question was, what happens in the future. The answer is, I don't know. Nor do the people who have devised this procedure. The reason I say that is that the longest time at this point, and we have been responsible for some of the research for this product, has not exceeded two to three years follow up. In that time, we have not, and I want to emphasize NOT seen an adverse effect. That doesn't mean that can't come at five, seven or ten years. It comes down to treatment options. If you take the disk out to do an anterior fusion, then the disk is gone forever. If you simply try to alleviate the pain with the IDET procedure, then other treatment options may come available as we increase the science of treating these disorders. One of the options is that we're doing at the Texas Instutute, one of five in the US, we implanted artificial disks. The purpose was to not do the spinal fusion. Once you fuse a segment, that segment becomes stiff and the segment above or below becomes stressed and will, with time, deteriorate. The artificial disk, like the knee or hip, allows that joint to continue to move and therefore spare the other segments. Personally, I would not recommend a spinal fusion in a young person if there are other treatment options. Only if the patient does not fit protocol for IDET procedure would I suggest that a fusion be considered.
Taken from Dr. Rosenbaum, MD

now has she tried this procedure? was it an option?

No she has never tried this procedure. We have never even heard of it just checked it out at google. That option was not given to her, but still could be an option if approved through workmans comp or the other insurance company. I will have her call and ask her laywer. Thanks bro.

**ludakris9** · 09-21-2005, 02:29 PM

Originally Posted by Doc.Sust

has she seen a pain management specialist?neurologist?

She has been to two diffrent neurologists. She was supose to go to pain management, but workmans comp is being a pain and approved it then cancelled it on her the day before the oppointment twice. She might just have to pay for it on her own. What would pain management do diffrent to help? Do they just help you deal with the pain?

***Doc.Sust*** · 09-21-2005, 02:41 PM

Originally Posted by ludakris9

She has been to two diffrent neurologists. She was supose to go to pain management, but workmans comp is being a pain and approved it then cancelled it on her the day before the oppointment twice. She might just have to pay for it on her own. What would pain management do diffrent to help? Do they just help you deal with the pain?

thats about it. they don't really solve the problem, i am not a fan, but it is a last option. i would try accupuncture first. if shehasn't tried it, give it a whirl. i don't know a great deal about chinese medicine, but i have a friend who studying this as we speak and has had amaing success with this as apatient and now as a studying practcioner. when all else fails, it is worth a shot, the options in this paticular case are limited.fcuk work comp!!!bastards!!!i deal withthem every day, they are always trying to not pay for therapy. it happened with 2 of my patients in the last 2-3 months. they hd my cases peer reviewed by other doctors to see if treatment was neccessary. i won both times. tell thatlawyer to do his job and get those jerks to pay!!!!they owe your sister.

**ludakris9** · 09-21-2005, 03:54 PM

Doc.Sust thanks for all the info I will let my sister know thanks. Hey your on my bb site so I will be talken to ya later bro. Yeah workman com does suck.

**dragon69** · 09-21-2005, 07:14 PM

Doc I'm onboard now and have read the post. As you know I am a specialist in diskoidal injuries in my practise. I disagree with you that disk injuries are permanent. Sure the inner annular fibers won't become one again, but the shape of the disk (which is what is most important) is completely changable (do it everyday at work). The outer Annulus is most likely to be intact, otherwise surgery would NOT have been optional.
Solving misalignments in this case is important and helpfull, however positional exercises prove to be extremely powerfull in influencing the shape of the disk.
Of course there will be muscular components as well, as this case is obviously a case where there is an unresolved whiplash. IMO Longus Coli is extremely ignored in whiplash cases and will be a HUGE factor in this case. It is IMO the missing element in treating whiplash cases and produces wonderfull results. However since most practisioners do not know how to address and treat Longus Coli, she will need to find someone who does (good luck there). Pecs and Scalenes should also be hit in the same session, with pecs being more like the 'KEY' to unlock the neck before the Longus Coli treatment. Once treated, the flexion forces upon the disk will be somewhat relieved and positional exercises will now be used in conjunction with therapy to Slowly reform the disk. This time would also allow chiropractic to become much more effective than ever before.
Another thing that comes to mind is 'what is the REST of the body like'? With violent trauma there are usually very badly screwed up pelvises. Doc as you know, a pelvis that's badly misaligned has profound ramifications through the entire body and can cause quite severe neck problems. Also, there are very few that treat it PROPERLY as well. My feeling here is that there is ALOT here that has not been looked at as of yet.

Now, to the poster.....I have no idea what area of the world you are in. My office is in Vancouver, British Columbia. I hope you are near enough as I have successfully treated many of these kind of cases. Otherwise, I will do what I can to help you. PM me if you need, I don't check EVERY day, but nearly.
Push 1 of your fingers into some various places in her pectoral muscles btw, there is bound to be some sensitivity in there as well and will likely need those done too.
Any questions for me???
Oh and do you have a CT or MRI report you could send us to review?

DocSust, nice to have heard from you again. Do you have any questions for me about this case? You know where to reach me. This was kinda fun.

**dragon69** · 09-21-2005, 10:49 PM

You know it occured to me over dinner that C6&7 are screwy so that must mean that C5 is stuck into flexion on C6. Likely a postural problem over several years previous to the accident and the accident exposed and exploited the weakness.
The upper Thoracics surely would need regular manipulative techniques as well (I find seated works best for those).

Poster, could you maybe post some pictures of her neck from front, back and side?

**dragon69** · 09-21-2005, 11:26 PM

Poster (Ludakris), I have re read the thread and I wanted to add that she should NEVER from this point on recieve another Corticosteriod injection. Doc I'm sure you'll back me on that one. Corticosteriod injections can relieve pain for a time, but at the cost of deteriorating the area. It is VERY, VERY degerative and should NEVER be done again as she will progressively get worse. I have seen this many times in my practise and it's just disgusting.

Doc I've heard of that new artificial disk. Exciting. Surgery's still a crappy fix though. Doesn't correct the problems that got them there in the first place though. Also doesn't correct the disks above and below the operative one that are starting to go as well. So those ones will be next to go and surgery will done AGAIN. Makes more sense to get rid of the problems the caused the protrusion, let it heal and then all of em will be good and patient will have experienced much less grief.
The artificial disk is quite an exciting developement for emergency cases of acute impact trauma however. Keep me posted on that.

***Doc.Sust*** · 09-22-2005, 01:16 PM

Originally Posted by dragon69

Poster (Ludakris), I have re read the thread and I wanted to add that she should NEVER from this point on recieve another Corticosteriod injection. Doc I'm sure you'll back me on that one. Corticosteriod injections can relieve pain for a time, but at the cost of deteriorating the area. It is VERY, VERY degerative and should NEVER be done again as she will progressively get worse. I have seen this many times in my practise and it's just disgusting.

Doc I've heard of that new artificial disk. Exciting. Surgery's still a crappy fix though. Doesn't correct the problems that got them there in the first place though. Also doesn't correct the disks above and below the operative one that are starting to go as well. So those ones will be next to go and surgery will done AGAIN. Makes more sense to get rid of the problems the caused the protrusion, let it heal and then all of em will be good and patient will have experienced much less grief.
The artificial disk is quite an exciting developement for emergency cases of acute impact trauma however. Keep me posted on that.

dragon,
amazing info, so glad to get your input, it was very insightful and right on.

totaly agree on the cotione shots, temporary relief at the price of permanent damage. not worth it, especially multiple times.

the artificial disc is a great concept, but like you stated there are so many cons along with the pros. it will take years of extensive studies and improvement on the initila disc itself as well as the procedure before it can be successful. may be impossible to slove the problem of the discs above and below from loseing there integrity. but yet, it is a giant step in spinal injuries.

tell me more about traetment of the longus coli?!?!iknow nothing of this at all

***Doc.Sust*** · 09-22-2005, 01:30 PM

hope this helps ludakris. and mri or ct reportswould be able to let us know how serious this can be, if you get them you can fax them to my office, pm me and i will give you the info.

***Doc.Sust*** · 09-22-2005, 02:01 PM

i agree and disagree about the whole permanent injury issue. it is different for everyone, alot of people i know have herniated disc anf feel absolutely no pain, many others have symptoms for life. my point is if you do or do not feel pain, from a legal stand point(i deal with way to many lawyers, i do all personal injury cases) the disc will always be altered..the annular fiber do not repair. for a limited tort auto case this is imperative because you must prove that there is permanent damage to win a case. so my statement was made thinking in those terms. but personally from my experience i have had alot of cases where people improved tremendously with "disc" but never were back to 100% of what they were before the accident.
loved this thread, keep checking on this forum, we can do some great work together

**ludakris9** · 09-22-2005, 03:27 PM

Originally Posted by dragon69

Doc I'm onboard now and have read the post. As you know I am a specialist in diskoidal injuries in my practise. I disagree with you that disk injuries are permanent. Sure the inner annular fibers won't become one again, but the shape of the disk (which is what is most important) is completely changable (do it everyday at work). The outer Annulus is most likely to be intact, otherwise surgery would NOT have been optional.
Solving misalignments in this case is important and helpfull, however positional exercises prove to be extremely powerfull in influencing the shape of the disk.
Of course there will be muscular components as well, as this case is obviously a case where there is an unresolved whiplash. IMO Longus Coli is extremely ignored in whiplash cases and will be a HUGE factor in this case. It is IMO the missing element in treating whiplash cases and produces wonderfull results. However since most practisioners do not know how to address and treat Longus Coli, she will need to find someone who does (good luck there). Pecs and Scalenes should also be hit in the same session, with pecs being more like the 'KEY' to unlock the neck before the Longus Coli treatment. Once treated, the flexion forces upon the disk will be somewhat relieved and positional exercises will now be used in conjunction with therapy to Slowly reform the disk. This time would also allow chiropractic to become much more effective than ever before.
Another thing that comes to mind is 'what is the REST of the body like'? With violent trauma there are usually very badly screwed up pelvises. Doc as you know, a pelvis that's badly misaligned has profound ramifications through the entire body and can cause quite severe neck problems. Also, there are very few that treat it PROPERLY as well. My feeling here is that there is ALOT here that has not been looked at as of yet.

Now, to the poster.....I have no idea what area of the world you are in. My office is in Vancouver, British Columbia. I hope you are near enough as I have successfully treated many of these kind of cases. Otherwise, I will do what I can to help you. PM me if you need, I don't check EVERY day, but nearly.
Push 1 of your fingers into some various places in her pectoral muscles btw, there is bound to be some sensitivity in there as well and will likely need those done too.
Any questions for me???
Oh and do you have a CT or MRI report you could send us to review?

DocSust, nice to have heard from you again. Do you have any questions for me about this case? You know where to reach me. This was kinda fun.

She has 2 mri's one was from the beginning july2003 and one from april2005. The to nuerologist are also from two diffrent states next two each other. She has all of her diagnosis ect. She doesn't even have full movement of her neck back yet.I will pm you with more info in a few bro. Thanks for both of you trying to help my sister out.

**ludakris9** · 09-22-2005, 03:31 PM

Originally Posted by Doc.Sust

hope this helps ludakris. and mri or ct reportswould be able to let us know how serious this can be, if you get them you can fax them to my office, pm me and i will give you the info.

I will pm you in a while and fax you those thanks bro.

**dragon69** · 09-22-2005, 07:05 PM

Originally Posted by Doc.Sust

i agree and disagree about the whole permanent injury issue. it is different for everyone, alot of people i know have herniated disc anf feel absolutely no pain, many others have symptoms for life. my point is if you do or do not feel pain, from a legal stand point(i deal with way to many lawyers, i do all personal injury cases) the disc will always be altered..the annular fiber do not repair. for a limited tort auto case this is imperative because you must prove that there is permanent damage to win a case. so my statement was made thinking in those terms. but personally from my experience i have had alot of cases where people improved tremendously with "disc" but never were back to 100% of what they were before the accident.
loved this thread, keep checking on this forum, we can do some great work together

Yes as I mentioned before the annular fibers won't magically become intact again, but I was saying that the SHAPE of the disk is what was important recovery wise. See, I have loads of patients come in that have told that they need surgery, yet CT doesn't show the need nor does any of my special tests. Doctors usually look at these cases so blindly and 'surgery, the only way to get better' or they'll give you some Amitryptoline and expect that to work miracles. God damn retards.
Perfect case to use as an example is CTS. How many actual cases of CTS have you seen without it being Lunate dislocation, Scalenes, Pronator Teres, TOS, C7/T1/R1 misalignment etc? How many botched diagnosis and unnecessary surgeries do we need to have before someone clues in? I see it so often it makes me sick.
BTW, my success rate with diskoidal injuries has been 100% thusfar, with only 1 case of a true outer annular tear. The only problem is however then, because of some torn annular fibers there will increased risk of re-lapse. but that's why I coach them and give them long term management skills so this doesn't happen.
Glad you liked my info, glad you asked me too!

**dragon69** · 09-22-2005, 11:32 PM

Oh yeah, Longus Coli...
Well, recall from anatomy that it is a prevertebral muscle from about T5 up through the C's. When this is spasmed (as a violent whiplash would cause some tearing) it will cause flexion throughout that region (some of the people that have that classic humping of the upper T's will have had it originate with longus coli spasm) and force the C's to compensate with extension. Surely you've seen many cases where the posterior cervicals wouldn't release and are constantly super tight, well that can be due to pectoralis (major and minor) tightness or spasm of Longus Coli or both (likely).

Actually I treated a chiropractor I work with the other day and he had SCMs and Trap/Levator that wouldn't let go. So I told him to hang tight and did Longus Coli on him. When I was done, I no longer needed to do SCM or Post Cerv's as they released themselves. He was suprised at the result and had very obvious change through the upper T's through low C's afterwards.

Now I'm not sure I should include instructions on treatment as this forum is read openly and we wouldn't want some untrained yahoo trying it on someone. I will PM you with that.

***Doc.Sust*** · 09-23-2005, 09:03 AM

Originally Posted by dragon69

Yes as I mentioned before the annular fibers won't magically become intact again, but I was saying that the SHAPE of the disk is what was important recovery wise. See, I have loads of patients come in that have told that they need surgery, yet CT doesn't show the need nor does any of my special tests. Doctors usually look at these cases so blindly and 'surgery, the only way to get better' or they'll give you some Amitryptoline and expect that to work miracles. God damn retards.
Perfect case to use as an example is CTS. How many actual cases of CTS have you seen without it being Lunate dislocation, Scalenes, Pronator Teres, TOS, C7/T1/R1 misalignment etc? How many botched diagnosis and unnecessary surgeries do we need to have before someone clues in? I see it so often it makes me sick.
BTW, my success rate with diskoidal injuries has been 100% thusfar, with only 1 case of a true outer annular tear. The only problem is however then, because of some torn annular fibers there will increased risk of re-lapse. but that's why I coach them and give them long term management skills so this doesn't happen.
Glad you liked my info, glad you asked me too!

i have seen the carpal tunnel mis diagnosis time and time again. it makes me sick too. it is ridiculous how many times i have een thoracic outlet syndrome overlooked. dragon, you know the game well. thanks for the insight and lok forward to reading more on longus coli treatment.

luda, be in touch, get us the mri's asap.