Question
Sir,

I'm a 28 year old Female who was in a Motor Vehicle Accident in 2003, I was diagnosed with a C1 Fracture and Occipital Condyle fracture L4/L5 fracture. The fractures didn't require surgery I wore a hard neck brace for about 12 weeks. Since then I've had chronic neck pain headaches and low back pain.  

I had and MRI last year of my lower back which indicated the following

T-12-L1 Small posterior bulging disc
L1-2 Small posterior bulging disc
L2-3 Mild posterior bulging disc
L3-4 Mild posterior bulging disc. Early bilateral joint facet degeneration
L4-5 Mild/moderate borad-based posterior bulging disc slightly larger on the left. Ligamentum flavum hypertroyphy and early joint facet degeneration
L5-S1 Right paracentral posterior herniated disc and annular tear. Small extruded disc material is present adjacent to the posterior-superior aspect of the S1 vertebral body. Ligamentum flavum hypertrophy and mild joint facet degeneration

I also recently had xray's of my cervical spine which indicated the following.

1. Loss of normal cervical lordosis. This may be present with spasm.
2. There is old dens fracture present
3. Mild degenerative change involving the left neuroforamen at the C5-6 level.

After these xrays I had a cervical MRI done. Which came back normal. So could you please break this down for me and explain what exactly is wrong with me, how my cervical xrays could say one thing and my MRI be normal also how I was diagnosed in 2003 with a C1 fracture but have an old dens fracture present? Isn't the dens considered the C2? Also any advice on treatment and or pain management. I thank you you so much for your time regarding these issues.

Answer
Dear Amy,

I can't tell you why you have pain, but I can give you some ideas.

First of all, when you sustain an injury, such as you did with the car accident, not only do you potentially break bones (fractures), but you also damage soft tisssues, such as ligaments, discs, muscles, etc.  The good news is that bone fractures/breaks are relatively easy to see and diagnose, and they heal up nicely.  The bad news is that soft tissue injuries (ligaments, discs, muscles, etc) are often very hard to see/diagnose, and can result in chronic pain symptoms that are hard to define and find.

Let's consider, for example, your neck injuries.  You evidently sustained significant forces during the neck trauma that were enough to break the Dens (C2), and the occipital condyle.  It is also possible, from what you report, that you fractured the Atlas (C1).  Now, if your poor neck underwent enough force to fracture 2-3 bones, do you think that maybe muscles, ligaments, and maybe even discs were damaged?  Damage could be anything from a total rupture (usually easily seen) to a microfilament diffuse tear (impossible to see on MRI or x-ray).  The later injury would result in joint instability, chronic muscular and ligament strain, mechanical dysfunction of the joint, resultant muscular spasm, etc.... all of which translates into pain, instability of the joint, and eventually, joint degenerative changes.

The lower back, for example, is already progressing through degenerative changes. You have multiple levels of disc (soft tissue) bulging and anular fiber tears (tearing, damaged discs), ligamentum flavum thickening (soft tissue, ligament damage), and facet athrosis (joint degenerative arthrits, the end result of mechanical problems and joint damage).  Disc problems in the lower back often cause nerve irritation, resulting in not only back pain, but pain, numbness, tingling, weakness in one or both legs.  I would be surprised if you were not having these types of "sciatica" symptoms extending down either or both legs.

In a nutshell, we do not heal from all injuries.  For example, if you had lost an eye, you would never expect your body to grow a new eye.  The same is true for many other tissues of the body. Ligaments and discs do not heal well at all.  Soft tissue injuries often result in chronic instability and pain.  Bones usually heal nicely, although there are some exceptions to that rule as well.  Even the skin, when it heals, often doesn't heal completely, resulting in ugly scars.  Muscles and ligaments, if they heal at all, often are laced with ugly "scar tissue", which renders the ligament/muscle/tendon less functional, more thick, more prone to causing mechanical problems... and more pain.

I am simply talking about injuries in general, and not about yours specifically. Only a qualified physician can give you ideas and thoughts about why you in particular are suffering ongoing pain.  You should find local doctors that you trust. If your current doctors are not giving you answers that make sense, then it is time to find other ones.

I hope that this gives you some ideas about your body, your injury, etc.

Keith Biggs, DC
http://www.eastmesachiropractor.com