Question
I was rear ended in an auto accident at a high speed. Two and one half years later..I had done 4 cervical epidurals, 3 thorasic epidurals, a right shoulder major rotator cuff tear surgery, a left shoulder acromioplasty and chronic neck, shoulder and back pain. A discogram discovered 2 buldging disc.  They were the C4-C5 and C6-C7.  The health insurance would not allow me a nucleoplasty which I appealed for and was denied.  The reason was they felt it was a experamental procedure.  The ortho doctor recommending a fusion.  I have heard only bad things from numerous people who have had them first hand? I have heard of a flexible fusion also. Is a flexible fusion possibly standard today or is it considered an  experimental procedure also.  I am scared to death!  I have a 4 inch scars on each shoulder. With a scar across my neck from the fusion I will not even need to dress up for Halloween.  I will look like Frankenstein all year long!

Answer
Dear Kandi,

The first thing I would do here is consult an attorney.  Your insurance company is giving you the run around.  Nucleoplasty is not and experimental procedure...thousands of them have been performed and they are much less invasive than a fusion.  I would avoid a fusion surgery unless you absolutely have no other choice as it will definitely lead to further surgeries sown the road.

Unfortunately, I think you may have been mislead as well throughout this entire process.  Rear impact collisions do have a reputation for being particularly nasty, but I am absolutely sure that some diagnoses have been missed.  For example, I am about 99% sure that you have torn ligaments in your neck as well as the disk bulges.  I would bet that the anterior longitudinal ligament, the posterior longitudinal ligament, and the capsular ligaments are all damaged.  This will lead to chronic neck, upper back, and shoulder pain...sound familiar?  

This has been well documented in the medical literature, however many physician are not ware of how to diagnose these injuries, how to treat them or how to document them.  You will need flexion/extension x-rays views of the neck, and then the movement of each vertebra can be measured to determine the amount of damage.  This is outline in the 5th edition of the AMA's guidelines to permanent injuries...every physician should have a copy and know how to perform these measurements, unfortunately they don't.  Second, a special MRI should be ordered called a FLAR study (fluid attenuation) and the radiologist should be asked to pay special attention to the ligaments around the spine and the upper cervical complex (especially if you are also experiencing chronic headaches)...I find these injuries on almost all rear impact collision injury patients...because I actually look for them.

Now if there is a significant ligament injury, more than 4 mm excursion, then yes you should consider fusion surgery but only after you have tried chiropractic and active rehabilitation to promotes proper scar tissue formation.  You see if the scar tissue does not form properly this actually leads to chronic pain and reduced function.  Rehab should have been the focus of your injury from the start.  The disk in juries also respond to rehab.  Decompression techniques such as directional traction and expanding ellipsoidal traction work very well, and have been proven to reduce disk bulges on follow-up MRI study.  This should have been included in your active care program.  Realize that epidural shots, and facet block will not fix anything, they only cover up the pain while leaving the injured tissue there to get worse.  I must also wonder why they would want to cut away part of the acromium from your shoulder joint this will only create instability.

Anyway, I would consult an attorney on this...your insurance company does not care about your or your recovery...they only want to stop paying your bills.  I would also recommend that you try chiropractic care and rehab for your ongoing issues, get the imaging techniques i have suggested, and only after that consider the fusion surgery.  If you consider the fusion surgery, I would suggest that you go with a neurosurgeon or an orthopedic surgeon who has completed a spine fellowship only ...not a regular orthopedist.

Good Luck Kandi, feel free to write back if you need to.

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