Question
I was the driver of a vehicle that was stopped when I was hit by a DUI driver from behind at 65mph.  This occurred on 04/28/08.

Immediately following the collision, I had pain and stiffness in my neck, and tingling in my left facial cheek.  Severe pain in my neck, mid, and lower back set in within two hours.  Extreme paresthesia in all of my extremities, and lower face set in within eight hours.

A cervical and lumbar MRI was done two days following the collision. These are the results:

Cervical MRI:
    IMPRESSION:  No evidence for fracture or ligamentous injuries, Mild reversal of cervical lordosis, Mild degenerative disc at C4/5 with possible annular fissure.
    SPECIFIC:  At C4/5, mild anterior intervertebral disc space narrowing is present.  Diffuse disc-osteophyte complex flattens the thecal sac, but does not result in central stenosis.  Linear T2 hyperintensity is present within the posterior aspect of annulus. No neural foraminal narrowing is present.

Lumbar MRI:
    IMPRESSION:  Mild disc degeneration at L4/5 associated with a small posterior central annular fissure.
    SPECIFIC:  At L4/5, mild posterior intervertebral disc space narrowing and decreased disc signal are present.  Minimal circumferential annular bulge flattens the thecal sac and is associated with a small posterior annular fissure.  No central spinal stenosis, neural foraminal narrowing or neural impingement is present.

I had a Thoracic MRI done three weeks later.  This is the report:
    IMPRESSION:  Mild bulging disc in the lower cervical, C6/7, C7/T1,T3/4,T4/5 levels are seen.  No evidence of significant spinal stenosis or forminal narrowing is present.
    SPECIFIC:  Mild degenerative changes of the upper thoracic spine and lower cervical spine are seen.  Artifacts in the thoracic spine, at the thoracolumbar juction are present however.  The thoracic cord is normal in size and signal.  There are pulsation artifacts within the thecal sac.  Mild bulging disc at T3/4 level is noted.  Mild bulging disc at T4/5 also noted.  The cord terminates at T12 level.  There is posterior mild bulging disc at C6/7 and C7/T1 levels in the lower cervical spine noted as well.

My pain in my neck and lower back has persisted, at a constant level of 5-6, increasing to 7-9 on exertion, exercise, or prolonged position (static sitting, or standing).  My paresthesia in my extremities has decreased overall in intensity, but persists, is constant, and also increases with activity.  I have also developed intense radiculopathy burning in my arms and legs, radiating down to my fingers and toes, along the C8 dermatomes, and the L5/S1 dermatomes.

The doctors of my HMO have failed to diagnose or treat any of my issues, having labeled everything as "Degenerative Disc Disease".  

I have taken NSAIDs for over a year, resulting only in increased reflux issues.  I have taken Neurontin, Lyrica, Flexeril, Zanaflex, Norco, and have found nothing that provides relief.  I took the 6 day Medrol (Methylprednisone) course, which increased the radiculopathy and paresthesia.

I have tried chiropractic, physical therapy, accupuncture, traction, and TENS therapy.  My symptoms and pain persist.

I have seen several physicians within my HMO.  None have seemed to be able to diagnose my issue, either because they were not knowledgeable or because their focus was too narrow.  I had two neurologists tell me "There are somethings in medicine we can't explain" and "All you need is a positive attitude, because that does more than any doctor can do for you."  I have seen four neurosurgeons, who only would address one area (cervical, lumbar).  The surgeons all said they saw issues, such as arachnoiditis and ligament damage, but nothing they would recommend treatment with surgery.  They told me it was not their job to diagnose any issues, and referred me back to the neurologists.

I had a DMX video fluoroscopy of my cervical spine done by an outside doctor.  This was the report:
    IMPRESSION:      Lateral translation greater than 3.5 mm during both left and right lateral bending indicates laxity of the right and left alar ligaments respectively and suggests possible instability. Correlate clinically.
   Anterior translation of C2 and C3 during flexion indicates posterior ligamentous laxity at those levels.
   Posterior translation of C2, C3, C4 and C5 during extension indicates anterior ligamentous laxity at those levels.
   Degenerative disc disease C4/C5-C6/C7.
   Hypolordosis, possibly due to myospasm.  

    SPECIFIC:  Standard fluoroscopic views of the cervical spine are submitted for interpretation. There is straightening of the cervical lordosis. The intervertebral disc spaces C4/C5-C6/C7 are diminished in height. Overall bone density is adequate.

    FLEXION AND EXTENSION MOTION OF THE CERVICAL SPINE:   During flexion, there is a 2.0 mm anterior translation of C2 with a 1.0 mm translation of C3.  During extension there is a 2.0 mm posterior translation of C3 and C4 with a 1.0 mm translation of C2 and C5.

    FLEXION AND EXTENSION MOTION IN THE OBLIQUE POSITION:   During flexion and extension there is contiguous motion of the facets with patency of the intervertebral foramina from that noted during neutral posture.

    LATERAL BENDING MOTION OF THE CERVICAL SPINE:   Left and right lateral bending demonstrates normal intersegmental motion.

    LATERAL BENDING MOTION OF THE UPPER CERVICAL SPINE:   During right lateral bending there is a 3.0 mm lateral translation of C1 upon C2. There is a 4.0 mm lateral translation noted during left lateral bending. There is associated narrowing of the para-odontoid space during both left and right lateral bending.

    ROTATION MOTION OF THE CERVICAL SPINE:   Left and right rotation demonstrate normal intersegmental motion.

I am coming to my wit's end.  I am in constant pain, with constant burning and tingling in my extremities.  I have seen several doctors, and none have so far put the whole package together and told me what is wrong, or offered a solution or prognosis.  I have tried all drug therapies, with no success.  No one seems to be able to treat the cause.

The outside doctor recommended prolotherapy to treat the ligament damage, and I am looking into that, but it is not covered by my HMO.

Can you provide any recommendation or possible treatment routes to follow?  I am an active person, a law enforcement officer, and am desperate to return to my former life.

Answer
Hello, Jason,

Ligament damage is a red herring.

The one thing in this report that has any useful meaning is this line:

       Hypolordosis, possibly due to myospasm.  

Myospasm means muscle in contraction -- triggered reflexively by the original incident and maintained as an ongoing action.  The result, consistent with your description, is disc bulge and nerve impingement.  Lordosis is curvature of the spine, affected by muscular tension of spinal muscles.  Straightening of the cervical (neck) lordosis (curvature) indicates muscular contractions in your neck -- outside the scope of practice of neurosurgery.

You can get free of the myospasm by means of clinical somatic education, a newly available health discipline.  Once free, the symptoms should begin to abate immediately.

The following article illuminates matters further:

http://www.somatics.com/whiplash.htm

with regard,
Lawrence Gold