Question
Im a 44 year old male with a history of Bladder Cancer and Spinal Surgeries.I had a accident  4/94 in witch i had a TBI of the brain and 3 surgeries to L5-S1 with cage fusion.I had cervical surgery on 3/02 at C6-C7 for arm pain.Recently i have been having dizzy spells,neck swelling and pain to the back of my head.I saw my Oncologist because he wanted to rule out and Cancer so he did a CT SCan.Here are the results
Foci of Aberrant soft tissue in the Maxillary sinuses
Anterioe cervical discectomy andd metallic fusion at c6-c7
Bony encroachment to the right C2-C3 Neural Foramen
Small central disc protrusion C4-C5
Disc Degeneration with anterior osteophyte formation C5-C6

The Oncologist suggest I see a Neuro Surgeon becauce i have been having these dizzy spells even when I drive.I would like your Opinion on these results if you can help me
Thank You

Answer
Dear Timothy,

Your history does not indicate the need for an additional  neurosurgical consult concerning the dizziness symptoms.  However, the MRI findings of bony encroachment of the C2/C3 may indicate a need for a neurosurgical consult.  Let me explain.

One the the hallmarks of traumatic brain injury and mild traumatic brain injury is dizziness, headaches, memory problems, irritability and sometimes combativeness, and mental fogginess (forgetfullness, loss of vocabulary, stuttering etc...  I see these issues in car crash patients all the time, and often times, MRI scans of the brain cannot find anything wrong because the damage occurs in the cellular structure of the neuron itself and the axons that transmit information from one brain cell to the other.  This is often called a diffuse axonal injury.  

We know this does occur because of monkey studied where the animals have been subject to crash impulses and the euthanized afterward so that brain biopsies can be performed.  The MRI scans are all normal, but dissection of the brain tissue yields diffuse damage at the microscopic level.  This diagnosis of diffuse axonal injury must be made clinically though because brain biopsy looking for these injuries are rarely performed.

Now switching gears, the nerves that exit the spine at the C2/C3 area of the spine have been shown to have correlation with dizzy symptoms as well, because of the inter-relationship with the trigeminal ganglion which relays information directly into the brain, and the proprioceptive mechanisms (body awareness signals from the tissue to the brain) of the upper neck musculature.  On the other hand, inner ear dysfunction can easily result in dizzy spells and has been shown to be a common problem after car crashes also.  So there are compounding issues to deal with.

Bottom line hear is that you need to be clinically tested first with simple orthopedic and neurological tests to try and rule out inner ear dysfunction, proprioceptive dysfunction, cerebellar function, and dorsal column dysfunction.  Sounds complicated, but in actuality, this can be performed with about 10 clinical tests and would only take about 15 minutes to perform them all and document results. These test are routinely taught in chiropractic and medical school...all doctors should know how to perform them accurately.  Depending on what is found will determine where you should go next...to a neurologist, neurosurgeon, for a Brain MRI, etc...

As for me I perform these test regularly in practice if I have a patient who presents with dizzy spells or vertigo, and I can pinpoint a cause and treat them without advance imaging in about 70 percent of the cases.  Others I refer out for imaging, or to a local neurologist or ENT specialist.  Everyone has to be evaluated though.

As for chiropractors we do things that the medical professionals do not, such as check for fixation of the upper cervical spine to include the occiput which is the base of the skull.  Why...because if the joints are not moving properly, the proprioceptive system will be disrupted, and can often be improved with just a few adjustments in that area. Again this is just part of the clinical examination process.

Hope this helps Timothy, I do think you need to be examined further.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net