QuestionI was injured in an automobile accident 9 yrs ago. I have done numerous physical therapy treatments and injections but none have helped and I suffer with severe pain in my spine and muscles in my back. I can't seem to make doctors understand the severity of my pain. Recently, I had an MRI that detected an old compression fracture in my spine and a bulging disc in my neck and have been told there isn't a treatment for old compression fracture. My pain keeps me depressed (mainly because I can't make anyone believe me)and my mood is horrible because I hurt 24/7. I am seeing a pain management Dr and he has given me 3 injections in the bulging disc area and tells me that those should take care of all my pain in my spine. I beg to differ! I am in constant pain but worsens with the weather, such as front,and causes me to have severe pain in my spine that feels like constant pressure which feels like I have a ton on my head and feeling like I need someone to pull my head and feet to relieve pressure. My muscles in my neck,shoulders, and back stay tense constantly which also cause severe pain. Please help me understand this injury and explain why I have severe pain in my spine even tho the compression fracture is old and the only relief I have found is to lay on my back with legs elevated.
AnswerDear Tandy,
I am sorry that you sustained injuries in the accident several years ago. Let me help you to understand a few things, if possible. Please understand that I have very limited information about you and your case, so much of what I am going to tell you is based on assumptions.
First of all, it is true that there is not a lot that can be done to treat compression fractures in the spine, especially when they have been there for a while. This does NOT mean that you are no longer having pain in the region, it just means that there is not a lot that can be done to make additional corrections. When a vertebral body is fractured, it results in a permanent injry and deformity. It will, immediately at the time of injury, result in acute pain from the broken bone and swelling and inflammation. If you are lucky (and in most situations, this is the case) there is not going to be any cord or nerve root problems related to the compression fracture of the vertebral body. Treatment for an acute thoracic compression fracture can include a vertebroplasty, but not always. In fact, many insurance companies do not even pay for this procedure any more. A vertebroplasty is the injection of cement into the fractured vertebra in order to stabilize the bone. Most of the time, when there is a compression fracture, doctors simply allow for time to heal the bone. Now, when I say "heal the bone", that simply means that the vertebra is no longer broken. It does NOT mean that the bone is no longer deformed, and that there are no residual problems related to it. Do not equate healed fracture with assumed loss of pain. Compression fractures, when healed, continue to have mis-shapen bones.
If there is sufficient force to fracture a bone in your back... what did that force do to the ligaments and discs, for example? There are likely soft-tissue injuries that were sustained that can be permanant as well. When the vertebra is broken and mis-shapen, it is going to cause mechanical/functional changes at the area as well, resulting in altered forces being applied to bones and joints... this is a recipee for degenerative joint disease/arthritis, and compensatory muscular spasm/tightness, trigger points, etc.
Now, in regards to the cervical spine. If you have had a cervical disc bulge/herniation with pressue upon the cord or nerve roots, this is also typically a more long term/chronic problem. Discs do not heal very well, if ever. They have a tendency to continue to degenerate and dessicate over time, especially after an injury to the joint.
Your doctors probably do believe you when you say that you are in pain, but they also have limitations in what is available to help you with your pain and condition. Lets look at this from a doctor's point of view, regarding treatment options:
1) Physical therapy, Chiropractic care: If this is the treatment that is given, there is a hope of reducing symptoms by helping the patient to become more functional, more flexible, and stronger. Notices that I did not say that these types of treatments will make you grow a new and perfectly formed vertebra in place of the old fractured/deformed one... and they will NOT make you grow a new disc in your neck. They might, however, help to stabilize the damaged regions. The problem is that if they are helpful, the patient is released from care, and then the patient usually stops doing the exercises at home and stops getting chiropractic adjustments. If you stop what was working, you will cease experiencing the benefits.
2) Pain medications. Not a good long term solution, due to the negative side effects that come with EVERY medication. Again, these will not make you grow a new bone in your back or make you grow a new disc in your neck. They will simply, for a limited amount of time, perhaps deaden your brain's ability to perceive pain. If you choose this route, you need, at the same time, to renew your efforts in #1 above. Active theapies are a much better long-term answer.
3) Epidural Injections. It sounds to me like your pain medicine doctor gave your 3 epidural injections into the spinal canal at the level of the cervical spine disc. This might ease your pain, temporarily, while the affects of the medication persist, but again, this is not a good long term answer because of the damaging impact that the medications can have on the bone and joints. If you get relief from epidural injections, you need to use the respit time to, again, renew your efforst at rehabilitative therapies listed in #1 above. Injections into the spinal canal will not make you grow a new vertebra nor grow a new disc in your neck.
4) Spinal fusion/decompression surgery. If nothing helps to take the pressure off of the cord and nerve roots, spinal surgery might be employed. Surgery does not make you grow a new bone in your back, nor does it make you grow a new disc in your neck. It "fixes" nothing, but simply cuts away damaged tissues and fuses damaged joints. This should be a last ditch effort... and if it is succesful in easing your pain, you should, again, go back to physcial therapy to improve function, flexibility, and strength.
Please notice that I have not offered a cure. I have talked about ways that you can try and manage your condition. There is no magic answer that will make your body go back to its pre-accident state. (I can't make my 50 year old body go back to how it was when I was 16 years old either!) In other words, your pain medicine specialist is trying to buy you some pain-free or pain reduced time. He is curing nothing. The same can be said for your general practitioner, or for your neurosurgeon, if you choose to go that route. Even your PT and Chiropractor are simply helping you to manage a bad situation. Do you have pain? I have no doubt that you do. It is obvious that your pain medicine doctor believes that you have pain as well, otherwise he would not have done 3 epidural injections into your spine/neck. Work with your doctors, but realize that there are limitations on what is available to help. Take charge of your treatment. Do not expect doctors to heal you. You must take actions to continue therpy/rehabilitation, long term, on your own in your home. Your doctors and therapists are simply guides to assist you and consult with you regarding options.
I hope that this helps you to understnad why you have more chronic pains. If you want more information, google search terms such as spondylosis, degenerative disc disease, disc herniation, spinal arthritis, Cervical Radiculopathy. Be careful of the sites that you read. Pay special attention to sites that are NOT simply advertisements for doctors or clinics. They will promise you the moon! I really like Wikipedia because it tends to be less biased.
Good luck,
Keith Biggs, DC
http://www.eastmesachiropractor.com
