QuestionQUESTION: Dear Sir,
I am a 30 year old wife and mother of one. I have always been very healthy and active. I have had neck pain for about fifteen years with no known cause. Two years and five months ago I began experiencing chronic dizziness. I have seen EVERY specialist known to man. Inner ear has totally been ruled out by several opinions. I was able to get an MRI which showed a slight disk protrution. By which my Neurologist said that everybody has bulging disk, not to worry. Meanwhile searching for anyone who would try to help me, I started treatment with a Chiropractor. He has been manipulating for about 8 months now. Well, yesterday he made an adjustment that sent me for a 'loop'. Meaning, the left side of my face went numb, vision was changed in left eye and dizziness was worse than ever ( on the verge of passing out over and over). Had a new MRI which shows the following:
FINDINGS: Normal signal is seen within the cervical vertebral bodies and visualized portions of the cord and cervicomendullary junction. There is reversal of the lordosis centered in the mid cervical spine which may be partly positional.
C2-3: Within normal limits.
C3-4: Minimal broad based disk bulge. Central canal and neural foramina are patent. There is mild end plate and uncinate process hypertrophy asymmetrically worse on the right.
C4-5: Mild broad based disk bulge. Central canal and neural foramina are patent.
C5-6: Mild broad based disk bulge. Central canal and neural formaina are patent.
C6-7: Mild broad based disk bulge. Central canal and neural foramina are patent.
C7-T1: Within normal limits.
IMPRESSION: Mild cervical spondylosis.
* I was Office manager for a Neurosurgeon for 6 years and have become very familiar with medical terminology .... this however is beyond my understanding. I too am having involuntary movements of my neck, spasms, visual disturbances and not to mention TMJ. Thank you so much for your time. Please help!
Shanda P.
ANSWER: Dear Shanda,
Your newest MRI doesn't really have much information on it. Basically, you have a few minor/mild disk bulges that are not placing any pressure on the cord or the nerve roots, and there is degeneration at the C3/C4 level. This along does not account for the dizziness or additional symptomatology you are experiencing. The loss of the cervical lordosis (normal curve) is not promising, and will contribute to continual degeneration and disk pressure, but should not be causing the symptoms you have reported either.
Words such as lordosis, patent, neuroforaminal, spondylosis, disk bulge etc... can be found with definitions and some illustrations on my website in the glossary and chiropractic information section.
http://suncoasthealthcare.net/chiropracticinformation/discherniation.html
http://suncoasthealthcare.net/glossaryofterms/
Now, The left side numbness and vision changes could have been caused for a few reasons. Too much neurological stimulation of the trigeminal ganglion in the neck which has direct connections to the cranial nerves (supplying information to the head and face), can cause these symptoms, but it is usually temporary...15 minutes or so. Trigger point/muscle spasm referral pain can invest the entire face to include the jaw (TMJ), affect visual input, and create abnormal activation of receptors in the spine called proprioceptors which can produce dizziness.
Moreover, compromised blood flow through the vertebral arteries due to compression or vessel spasm post adjustment can cause these symptoms. If transient effects are noticed and then go away, then an arteriogram to image the vessels should be performed before any additional adjustments are given to make sure the spasms are not still present and to check the blood flow. If additional possible symptoms such as speech difficulties, facial droop, or arm weakness are or were present, this can indicate a reduction of oxygen perfusion to the brain [transient ischemic attack (TIA)/stroke symptoms] which needs to be addressed immediately. Although this is very rare, it has been reported to happen, and needs to be medically managed with IV therapy. If you are taking any contraceptive medication or if you smoke, this greatly increases your risk. This is not meant to scare you, but we must consider all options.
Lastly, if you have been treated by a chiropractor for 8 months, and you have not been getting any better, why have you continued to go? Although adjustments to the upper cervical complex often reduce dizziness, and pain, some form of rehab should also be performed to address the loss of neck curve, and the muscular and ligamentous structures of the neck. If this is not being addressed, you need to find a better chiropractic physician. One who will perform a comprehensive examination, and tailor a treatment plan with specific goals in mind to address pain reduction, eliminating dizziness, and restructuring the spine. This should have a timeline associated with it to assess clinical progress and whether or not continued care is advised or if additional testing is needed according to the re-exams and any progress attained.
Shanda, make sure you follow up on this information, and feel free to write back if you need clarification or more information.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net
---------- FOLLOW-UP ----------
QUESTION: Dr. Leatherman,
First I want to thank you for your time in answering my questions. I have had a difficult time finding ANY physician who has been willing to take the time to help. Which will help in answering the question you had about my continued treatment with this Chiropractor with minimal result. First, he was the only specialist who has shown any interest in my condition and who also offered an active plan to treat it. I have had some neck pain relief since starting treatment. The degree of dizziness has been reduced slightly.... which could also be contributed to the fact that I have had less anxiety knowing that someone had an active plan?? I also wanted to mention that in the area in which I live we are limited in 'quality' specialists. Partly because the malptractice insurance is too high and has forced doctors to move out of state to practice. Not that I'm not willing to travel for treatment, I just can't get anyone to refer me to where I need to go! Simply because they don't know what's causing my symptoms. If you would recommend that I see a doctor in ... Africa, I would go. So, if you have any recommendations please feel free.
You also mentioned that I need to get some kind of rehad to address the structural problems. What type of practice offers this treatment? That way I can find one on my own. Physical therapist, Orthopedist...?
Is surgery an option for a patient like me? Based on the information you have, do you believe that the dizziness is related to the cervical issues? How much does TMJ play a role in this?
God bless you,
Shanda
Answered Question
Subject Vertigo/Cervical disk bulge/Neck pain
Question Dear Sir,
I am a 30 year old wife and mother of one. I have always been very healthy and active. I have had neck pain for about fifteen years with no known cause. Two years and five months ago I began experiencing chronic dizziness. I have seen EVERY specialist known to man. Inner ear has totally been ruled out by several opinions. I was able to get an MRI which showed a slight disk protrution. By which my Neurologist said that everybody has bulging disk, not to worry. Meanwhile searching for anyone who would try to help me, I started treatment with a Chiropractor. He has been manipulating for about 8 months now. Well, yesterday he made an adjustment that sent me for a 'loop'. Meaning, the left side of my face went numb, vision was changed in left eye and dizziness was worse than ever ( on the verge of passing out over and over). Had a new MRI which shows the following:
FINDINGS: Normal signal is seen within the cervical vertebral bodies and visualized portions of the cord and cervicomendullary junction. There is reversal of the lordosis centered in the mid cervical spine which may be partly positional.
C2-3: Within normal limits.
C3-4: Minimal broad based disk bulge. Central canal and neural foramina are patent. There is mild end plate and uncinate process hypertrophy asymmetrically worse on the right.
C4-5: Mild broad based disk bulge. Central canal and neural foramina are patent.
C5-6: Mild broad based disk bulge. Central canal and neural formaina are patent.
C6-7: Mild broad based disk bulge. Central canal and neural foramina are patent.
C7-T1: Within normal limits.
IMPRESSION: Mild cervical spondylosis.
* I was Office manager for a Neurosurgeon for 6 years and have become very familiar with medical terminology .... this however is beyond my understanding. I too am having involuntary movements of my neck, spasms, visual disturbances and not to mention TMJ. Thank you so much for your time. Please help!
Shanda P.
--------------------------------------------------------------------------------
Answer Dear Shanda,
Your newest MRI doesn't really have much information on it. Basically, you have a few minor/mild disk bulges that are not placing any pressure on the cord or the nerve roots, and there is degeneration at the C3/C4 level. This along does not account for the dizziness or additional symptomatology you are experiencing. The loss of the cervical lordosis (normal curve) is not promising, and will contribute to continual degeneration and disk pressure, but should not be causing the symptoms you have reported either.
Words such as lordosis, patent, neuroforaminal, spondylosis, disk bulge etc... can be found with definitions and some illustrations on my website in the glossary and chiropractic information section.
http://suncoasthealthcare.net/chiropracticinformation/discherniation.html
http://suncoasthealthcare.net/glossaryofterms/
Now, The left side numbness and vision changes could have been caused for a few reasons. Too much neurological stimulation of the trigeminal ganglion in the neck which has direct connections to the cranial nerves (supplying information to the head and face), can cause these symptoms, but it is usually temporary...15 minutes or so. Trigger point/muscle spasm referral pain can invest the entire face to include the jaw (TMJ), affect visual input, and create abnormal activation of receptors in the spine called proprioceptors which can produce dizziness.
Moreover, compromised blood flow through the vertebral arteries due to compression or vessel spasm post adjustment can cause these symptoms. If transient effects are noticed and then go away, then an arteriogram to image the vessels should be performed before any additional adjustments are given to make sure the spasms are not still present and to check the blood flow. If additional possible symptoms such as speech difficulties, facial droop, or arm weakness are or were present, this can indicate a reduction of oxygen perfusion to the brain [transient ischemic attack (TIA)/stroke symptoms] which needs to be addressed immediately. Although this is very rare, it has been reported to happen, and needs to be medically managed with IV therapy. If you are taking any contraceptive medication or if you smoke, this greatly increases your risk. This is not meant to scare you, but we must consider all options.
Lastly, if you have been treated by a chiropractor for 8 months, and you have not been getting any better, why have you continued to go? Although adjustments to the upper cervical complex often reduce dizziness, and pain, some form of rehab should also be performed to address the loss of neck curve, and the muscular and ligamentous structures of the neck. If this is not being addressed, you need to find a better chiropractic physician. One who will perform a comprehensive examination, and tailor a treatment plan with specific goals in mind to address pain reduction, eliminating dizziness, and restructuring the spine. This should have a timeline associated with it to assess clinical progress and whether or not continued care is advised or if additional testing is needed according to the re-exams and any progress attained.
Shanda, make sure you follow up on this information, and feel free to write back if you need clarification or more information.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net
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AnswerDear Shanda,
The functional rehab of the neck can be successfully performed by a good physical therapist under the direction of a competent diagnosis, but the structural rehab I had mentioned regarding the cervical curve should only be facilitated under a chiropractic physician with extra training on these protocols. You can find out more information on structural rehab by checking out this website: www.idealspine.com They have a physician locater on the site, so that you can additionally look for a doctor close to your area...it is broken down by state and then the doctors are listed by city.
Your concerns of surgery at this point are not valid because your disk problems are not severe enough to warrant surgical intervention at this point, and the fact that no doctor has been able to pinpoint the exact source of your dizziness. Unless your disk problems become worse, or the exact cause has been pinpointed concerning the dizziness, there is no reason for surgical intervention.
With the limited information I have from your correspondence, the fact that you stated that multiple doctors have ruled out inner ear causes of dizziness, I would have to opine that the dizziness symptoms have arisen out of dysfunction in the joints of the upper cervical spine, or the lower cervical junction with the 1st rib in the chest. This area when fixated and inflamed can alter blood flow to the brain at the subclavian/internal carotid area which may also produce dizziness...although shoulder pain and anterior low neck discomfort usually accompanies this presentation. There are simple orthopedic and motion assessments of the area to determine any functional problems that all chiropractic physicians are taught in school. I do not think that the TMJ is a primary source of your problems with the exception of jaw pain, but often upper neck dysfunction can affect the function of the TMJ.
Lastly, one other scenario to consider. You have some symptoms of multiple sclerosis, but it does not seem clear cut. This often presents with visual and abnormal sensory problems (ringing in ears, dizziness, sensation changes to the arms or legs, facial sensations or lack of muscle control etc...) These symptoms may disappear from time to time and then reappear, but clinically MS is a difficult diagnosis, and an MRI looking for plaques in the brain would rule it out. Again not trying to scare you, but trying to cover all the angles.
Good Luck Shanda,
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net
