Question
Hello!
Please help me. In 1996 I  I fall on ice and have a Herniation at C5-6, have a fusion done few months leter.In 2000 have a fusion done on C6-7. In 2004 have a MRI and it shows mild eccentric more right sided disk bulging, otherwise unremarkable study. In June 2005 I fall at work.I was on the way out in dark room, I bump with my right knee against a massage table fell backwards to the left shoulder, left elbow and left hip. I have a very sharp pain in my left arm, shoulder, and hip. After few days mostly a pain in my left elbow and numbness in my fingers.After fall doctor order X-ray of my neck and elbow and said that my neck is okay. So I didn't worry, I always have a stiffness and some pain in my neck. I have MRI on my elbow, shows some changes, I have a EMG, doesn't show any problem with my nerws.Ortopedic Dr. gave me few cortisone injections in my elbow.After injection in February 2006, I didn't see orthopedic for 7 months, finally I couldn't take that pain any more, I start to wandering if there is more to my injury, I saw him again in august 2006. I get cortisone injection again. I start to have some problems few months back with weakness in my legs, and then pain and numbness in my right leg in august 2006. I went to ER, they tell me that this is Sciatica pain. I F/U with Neurosurgeon, through my health insurance.He gave me Epidural injection it helps for little time, at this moment I still have a numbness in my right lower leg. I have been working all this time, then I lost my job in November. I go back to Orthopedic Dr. and tell him about my problem with my neck, He order MRI of C-spine.Report shows that I have a herniated disk (C4-5)with more to the right.I asked orthopedic why then there is pain also in my left arm,He said He don't know and that he will like me to have a consultation with Neurosurgeon. I didn't get approval for Neurosurgeon until 4 months later. When I go to see Neurosurgeon ( IME)He asked me where is my problem. I start explain that I have a neck pain and arms pain. He stop me and said that my problem is with my elbow that what Workman Comp. said. He said that my problem is that I have a fusion done, and asked me if doctors ever mention that I will have a problems. I don't know what He is talking about.He cancel my appt. saying that He don't know what is wrong with my elbow, and my problems are with my previous surgery. I try to look on Internet, and check if other people have similar problem, like get hernated disk without injury, because they have previous fusion.I can't find nothing, accept Athletes. I was injured at work and I cant get any help. Please help me on this subject.

Answer
Dear Krystyna,

Sorry to hear about all the problems you have been having.  The first thing I want to convey to you is that the Independent Medical Exam (IME) doctor you saw is not independent...he is paid for his opinion through the workers compensation program and will likely always generate reports that are in their favor.  So it is no wonder that he blew you off...his behavior was unethical and ridiculous. He should have evaluated the neck, the elbow and the hands. If I were you I would talk to an work comp attorney about this so that you can be made aware of your rights. I would additionally do an inquiry about the IME doctor to find out more information on his practice, relationship with the workers comp network and his medical license.  you are probably not the first person he has treated this way.

Now, there is some validity to what he said about having future problems after an initial fusion surgery, but that does not mitigate the point that you had a fall at work which caused you to have ongoing symptoms and pain which is not getting better.  Let me explain.

Anytime you have a surgical fusion to one level in the spine it cannot move appropriately.  This results in increased  movement of the adjacent vertebra to compensate for the lost function.  Over time, the adjacent areas will erode the disks and will create degeneration/arthritic changes and will become less stable.  People who have one fused level are prone to future surgeries for the same problem.  Their spines are less resilient and degenerate faster than normal.

With that being said, the injury could easily be the mechanism which has cause your increased pain/problems, and it does not matter that you had a previous surgery.  If you weren't having problems before the fall, or your pain was increased due to the fall, then you need to be treated for it under the work comp system.  It is unethical to deny you care because of a previous condition.  If a 20 year old and an 80 year old are in a crash and both injured, the 80 year old will likely be injured more severely due to previous conditions such as degeneration or surgery...it doesn't eliminate the 80 year old from appropriate medical care or management of the injuries...get my point.  Their argument is really invalid.

I Would really suggest that you hire a good personal injury attorney/work comp attorney to evaluate this matter.  hopefully they can get you in touch with a legitimate doctor for an accurate and true examination process fro better understanding of the current problem and appropriate treatment.  Depending on the diagnosis and progression, you may be facing yet another surgery or continuing pain management.

I wish I could do more to help Krystyna, Good luck!

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