Question
I just had a C5-6 Fusion. My symptoms were Chronic crown headaches,neck pain,some facial pain,ear pressure and fullness and occasional arm and finger pain. I am 3 weeks post op and nothing has changed. A different Neurosurgeon at Hopkins told me he thought it was upper cervical like C1-2. If it is what can be done ablout that?

Answer
Dear Tara,

Often neck injuries (fractures) have additional damage to the ligamentous and cartilaginous structures of the neck.  These structures can easily generate what is called referred pain patterns into the head and neck away from the principle injury site...sometimes even into the shoulders and low back.  Moreover, the upper cervical nerve roots and suboccipital nerves can be injured and inflamed which will almost always cause headaches.  If the pain is emanating form the upper cervical junction, chiropractic manipulation of the affected joint spaces can often immediately reduce your pain and suffering.  Extended care over a few months can sometimes eliminate the pain altogether.

The first thing that needs to be figured out though, is do you have instability in the upper cervical region.  If you have already had surgical fusion at C5, C6, upper neck instability has probably been ruled out, but the issue needs to be considered.  If the upper neck is unstable, then manual adjustments should not be used...instead a specific instrument such as an arthrostim, impulse, or activator should be utilized. **Another technique to aid in the diagnosis of the upper neck would be a special MRI called a FLAR study.  The radiologist should be instructed to look for ligament damage to the Capsular, Cruciform and Alar ligaments.**

Second, you have to heal from the fusion surgery before you can be worked on by a chiropractic physician.  This will take a minimum of 6-8 weeks, if an ACDF procedure was utilized.  If hardware was utilized on the back of the spine, it may take 10-12 weeks before you can be adjusted safely.  The surgical repair has to be stable first, and the soft tissue needs to have a good scar formation. You will also need to go through physical therapy to regain muscular strength in the neck, and it may be beneficial to start this a week or two before seeing the chiropractor.

Some neurosurgeons will state that you should not be adjusted, and some chiropractors refuse to work on patients with fusion surgery. But spinal adjustments can be very safe after fusion when precautions are taken. However, you should not be manipulated - or adjusted near the fusion site...the chiropractor should stay in the C1-C3 area of the neck or T1 and below if using manual techniques, instrument techniques can be utilized at C4 and C7 without issue because they require minimal muscular or joint movement.  Make sure you discuss your options with your treating doctor, and see if he can recommend a good local chiropractic physician.  
Hope this helps Tara.

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