Question
Dr Ornstein the last time i talked to you was 1/07/15,you told me that i might need a second opinion.I went seen a orthopaedics and spine specialist about my neck. Well that Dr sent me for another Mri but first wanted a copy of cat scan when i return with cds of cat scan and mri he told me that my neck healed back abnormal that a bone dropped down that he didnt thank i needed surgery he sent me to a pain management and interventional spine specialis. I go to this Dr and he ask me why I was there i told him he said he didnt put shots in c2 and he gave me noraco 5-325 after leaving i got papers from him it said degeneration of cervical in tervertebral disc chronic,cervical radiculopathy chronic,hnp cervical,and capsulitis,adhesive shoulder. I still dont understand none of this so i go and get report of my 2 mri it is of my cervical,lumbar spine without contrast.The conclussion of cervical said chronic fracture deformity at the base of the dens of c2 with slight anterior angulation deformity of the dens,Ventral cord abutment and mild right vental cord flattening results.Mild spinal canal narrowing.No gliosis within the cord at this level Shallow disc displacements or disc protrusions through out the cervical spine disc levels. Mild foraminal narrowing at the c3456 disc levels contributed to by uncovertebral joint hypertrophic change.Lumbar conclussion said chronic bilateral L5 spondylolysis or pars interarticularis defects with minimal 1 L5-s1spondyloisthesis. Shallow pseudodisc displacement or disc bulge slightly eccentric in the right foraminal location with mild right greater than left foraminal narrowing. Spina bifida occulta at this level. Ok I dont understand one bit of this I am still in alot of pain cant hardly do nothing riding to see these dr is a hour and a half when i get home i cant hardly get up and go get a glass of water for at least three days yes the pain meds help some.My question is is there hope for me to be able to do somethings i use to do will i be able to go to work. I asked dr if i should sign up for disability cant get no answer whats your thoughts on that. The only thing i can get out of dr he ask me why the dr that treated me back in 2009 didnt operate on me and why there wasnt a halo put on me i dont no them answers.That bone dropping down is this alot of my problem i cant turn head to left and i cant smell What should i do I need something done i have gained a 130 pounds i am on anti depression pill now got apt wit diet tican for weight i no this might help some but pain was there before i gained all the weight I cant give up i am a single Dad raising a 14 year old daughter the best i can with my conditions.

Answer
Hi James,

You have been busy.

Well, there is nothing that can be done with the poorly healed fracture; we can't go back in time. Evidently it is angulated and putting some pressure on the spinal cord. I assume they do not feel surgery would be advantageous. The effect is to have a cervical spine that does not function right. Biomechanically, degeneration results from the altered forces. This produces pain, chronic pain and the location of the upper cervical region is important and can result in many problems.

Medically, I am surprised they would not consider a spinal injection and just leave you with hydrocodone. It would seem beneficial to reduce any inflammation, and the results would indicate inflammation is present. There may be contraindications to oral steroids, so your medical history may play into this. The noraco 5-325 can help, I would think something like tramadol might be a better start.

Anyway, it is difficult imagining improvement with noraco 5-325 alone. I would question the doctor about disability, since you would need that evaluation and diagnosis for application. Additionally, pain management is not rehabilitation. Ask the doctor what is the prognosis in your case. Obviously, it is affecting your functional ability, is there a test for this?

I'm not sure if this can help, but a chiropractor who specializes in the upper cervical region may be able to effect enough change to make a difference. If I look up doctors for this technique, http://www.nucca.org/find_doctor_results.php?txtCity=&txtState=OH&txtCountry=&tx

I get results for Stow, Wapakoneta, Columbus and Findlay.

This might be something that can be done. I don't see any Grostic practitioners in your state, but even another low force, biomechanically oriented technique might make a difference, especially in that area, and especially since you are not being offered any type of corrective treatment plan. If they are saying nothing can be done but medicine, you should have a recommendation for disability. Call a local chiropractor and talk; looking for a low force, upper cervical technique.

There is nothing of similar significance in your lower back. I have an occult spina bifida. The spondylolysis is a result of a pars interarticularis defect. This is slipping of L5 forward on S1, but this is minimal. This can be painful, but nothing alarming, however, I would use a strong belt if you lift anything and avoid bending forward at the waist. If your back is an issue, a chiropractor or even a physical therapist could help. Lying on your back and pulling your legs into the chest can help with this. There is actually a chiropractic adjustment done using this position in combination with something called a drop piece on the adjusting table.

I think that weight management can help with forces on your low back, but a non-inflammatory diet might help overall. This is not easy I know, but a little can help - baby steps. Depression is a problem. I have a significant chronic pain issue, I know. Not to mention a young daughter to raise as well. That is why I suggested Tramadol, it has been shown to help with pain and depression. Not as addictive or as many side effects as hydrocodone. However, neither of them are anti-inflammatory and I have not heard that your doctor has recommended anything like Celebrex or another NSAID.

So, I hope I have given you some things to think about and some direction to take. We are not looking for a cure, but little things that will help and make a difference, no matter how small. Going in the right direction. It is an uphill battle. Even something like cognitive behavioral therapy may make a difference in the mix. There are things that can be done. Alone, it might not make a difference, but if you can combine some of these, it just might.

Regards,

Dr. Steve