Question
QUESTION: I was in a car wreck on 4/6/07, we were T-boned by a car going a high rate of speed. I had an MRI which showed bulging disk at T 3-4, T 4-5, T 5-6. Focal right paracentral disk herniation and associated radial tear at T 6-7. Focal midline posterior subligamentous disk herniation and associated tear at T 8-9. Approximation of ventral spinal cord at T 6-7 and T 8-9.

Since the wreck I have tried non-surgey treatments, for 7 weeks. My back is not getting any better, I have spams all the time, sharp shooting pain,throbing pain, my back is swollen and hurts to the touch in places. My right arms burns and is weak ( from the test I am 60% weaker on the right side, before wreck it was my strong side), my legs go to "sleep" no matter if standing or sitting.

Is it time to think about surgery? I have read this is the "critical zone" of the spine what does that mean?

Thank you for your time.

ANSWER: Dear Ellen,

I am not sure what types of surgical treatments you have tried, but these types of injuries take a long time to heal and it is common for patients to be in pain for months after the injury while rehabilitating their injuries.  Disk surgery is not always the best option, especially if the bulges are new, sometimes axial traction is a better option, although a radial tear and approximation of the ventral cord is not good news.

Side impact vectored collisions have a directional force to the mid and lower spine that result in a lot of torque and bending moments to the spinal column and this is the likely reason for the significant amounts of disk derangement visualized on MRI. I would also opine that you have either disk bulging/herniation in the neck, nerve root encroachment of a brachial plexus injury as well due to the right arm pain and loss of strength.  Has this been checked out?

What types of doctors have you seen for this so far, and what treatment has been rendered?  Give me some more information and I will give you the best recommendations I can based on the information.  In the mean time, please check out the below web-page for more information on disk bulges and herniations.

http://www.suncoasthealthcare.net/chiropracticinformation/discherniation.html

Respectfully,
Dr. J. Shawn Leathertman
www.sunicoasthealthcare.net

---------- FOLLOW-UP ----------

QUESTION:  Thanks for writing back.
I had really bad neck pain for a couple weeks after the wreck and my neck does hurt when I lean it over to my left shoulder. It was never looked at on an MRI. I have a lot of lower back pain but no bulges showed up so I don't know why it hurts I also have headaches every day.
I have been seeing a Chiropractor for 7 weeks, he does adjustments, uses a tens unit, and a hydro bed ( which feels like somebody is punching me in the back and most time I can't stay on it the whole time as it is very painful) He thinks I have a torn muscle in my back as well as there is a pretty big knot right by my spine that you can see the swelling from even thru my clothes. That is all the treatment so far.
I didn't mention this before but I am having to urinate like 30 times a day since the wreck. I am not drinking more than before nor is there any pain with it. I don't know if this is related in any way. I was so worried about I got tested for diabetes which was neg, along with any infections.
I can't take pain meds for several reasons. My husband sustained a brain injury from the wreck, I need to help him while he is rehabing and they are going to do surgery to release the pressure on his spinal cord and brain stem. His son who lives with us full time has type 1 diabetes and doesn't know when he is low so I test him a couple times a night. Bottom line is I have too many responsibility to take them. I did do a round of steroids which had no effect on the pain.

Thanks for your time,
Ellen  

Answer
Dear Ellen,

First of all, I hope you have an attorney involved with this case to protect you and your husbands interests concerning ongoing care and any future pain/problems.  you also need to make sure that everything that happens with medical and chiropractic care is documented fully in relation to the crash as well as the treatment.  I would also suggest that you get copies of all your records as you go along.

I am glad that you are getting adjusted at this point, but a tens unit in the office is a waste of time...you can use one of this at home to help with pain.  The chiropractor should be utilizing interferrential current or high frequency, or laser, or something else in the office which had more therapeutic value.  Tens is really only utilized for pain control and it is temporary.

Moreover you would do much better with some myofascial release procedures rather than the hydro bed.  Deep tissue massage would be beneficial to help eliminate the muscle spasms.  It will make you sore, but their will be a benefit after.

Urgency and frequency concerning urination is most likely due to irritation of the nerve supply in the low back and sacral area. The smooth muscle in the bladder is responsible for the contractions that help to void the bladder along with stretch reflexes when it is full.  Irritation to the nerves that supply the bladder will promote increased urges to urinate and a lack of bladder control.  this is something that should be checked out further due to the fact that the sensitive nerve fibers of the "cauda equina" can get compressed, if sever, then this can turn into a medical emergency where surgery may be your best resolution.  If you lose control of your bowels or bladder, you need to get to the emergency room immediately.

I think you should check out a website, it is to the Spine research Institute of San Diego:  http://srisd.com
you will find tons of information at this site on vehicle crashes and injury, and I think it will be an asset to you.  Additionally, you can find chiropractic and medical physicians who are certified in crash parameters and treatment who may be a help to you in your local area.

Please read over the information, and then get back in touch with me if you need to concerning comments or questions.  I have more detailed information I can send to you on vehicle dynamics and what the spine goes through in a typical crash, but it is geared more toward rear impact and side impact...let me know if you want the information.  I would also be willing to send you copies of our treatment protocols as we submit them to the insurance companies in relation to auto crashes, spinal injury and brain injury if you would like.  I wish you all the best.

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