Question
QUESTION: I was in a car accident a number of years ago.  Surprisingly, the only injuries were a concussion and an extremely strong pain in my (I now know) thoracic spine.  I'm usually stoic, but this HURT.  CAT scan, X-rays and perhaps MRI (no memory).  No injury was found. Three years later I asked my GP to order an MRI of my entire spine as I was having trouble standing at my part-time job.  The pain was in my C and L spine, not T.  My dr saw the results and sent me to a neurosurgeon.  His first words, he never did introduce himself, were "You are lucky you aren't paralyzed." I'll never forget those deadening words.  He continued to say that he had seen numerous cases like mine in the ER; a person was involved in a minor accident or fall and paralyzed--high enough in T spine to require a ventilator.  I procured a copy of the CAT narrative and the competent radiologist had noted that there was evidence of an old hematoma at the T7-9 site. (Accident) It seemed there were 'bone spurs' (not med jargon sorry)crushing my spinal cord at the lower T7, all T8, upper T9 (that's what I'm guessing as they were replaced with cages (plastic in the shape of "I") and a week later rods from T6-10 were inserted with pedicle screws.  I spent two weeks in rehab, which involved about 20 minutes total daily of PT.  When I was released, I mentioned to the committee that I lived alone and would have NO help.  The case manager had missed that salient point during the intake interview.  I was driven home and left on my own.  I fell the first week back, slipping on spilled dog food and even though I had my hard 'brace' on;  it hurt.  I called my surgeon who wasn't concerned. Then I fell two more times.  I couldn't afford the PT, which I wanted and still desire.  Eighteen months after surgery I finally strong-armed (somehow) my dr into doing a CAT to see how successful the surgery had been.  For some reason he refused to do any scans earlier.  Once again, the man of few words threw me for a loop when he saw the CAT.  He said, "Wow, look at this."  He then pointed out the tip of the lower right pedicle screw and my aorta.  They are so close there is no light between them.  So, I went home an had a nervous breakdown.  A second visit with the dr brought the minimally sarcastic comment that "it wouldn't kill me".  Hmmmm.  In 2007 my neurologist ordered an MRI of my C/T spine which showed severe stenosis of most of my C spine and specifically"chronic compression fracture of T8 with approx 60% loss of height anteriorly.  Another MRI was ordered recently and (as a side note) the radiologist who 'read' it was blind....maybe just seeing impaired.  It seems my C- spine has miraculously been cured and the only problem with my T-spine is "...bone cage at T7-8 protruding into the anterior spinal canal and effacing the ventral thecal sac, disc protrusion at T8-9.  
Did I need the original surgery, complete with a thoracotomy or could this have been fixed endoscopically?  I realize that if a cage (and it doesn't say in the narrative if the cage is the horizontal one or the vertical one) has moved then most likely there has been movement of the other two cages.  My other concern is:  Have I somehow bent the rods which I believe were inserted to help keep the cages in place?  Which also lead to the tip of the screw and my aorta and the German paper I just read about this exact problem and the screw had infiltrated the aorta causing 'unusual abdominal symptoms'.  Would exercise or other non-invasive options help with my C3-7 "left-sided uncovertebral hypertrophy leads to severe left-sided neural foraminal stenosis"?  Anything that would help with "high signal hemangioma of bone is noted within the body of L1."  I wish I had found your site prior to my surgery.
Would you be able to give me a shortlist of options?  I have osteoporosis, my spine is falling apart, but thankfully it still holds me up.  Unfortunately I am having problems walking, even short distances, with out extreme back pain, chest pain and now left hip and leg involvement.  I know that exercising, especially the abdominal muscles and those disturbed by the thoracotomy would be to my advantage.  Do you feel I will likely need re-surgery to remove the cage (which must have moved since last year as the former radiologist was excellent in his interpretation of my MRI)and prevent paralysis?  Do you suppose the cage has been crowding my thecal sac since my first CAT scan.  I recall the surgeon saying under his breath, "We're right back where we were."  Obviously I do not communicate well when I am stressed, in pain and not familiar with the problem area of the body.  I am currently using the lowest dose fentynal patch, hydrocodone (ho ho) for breakthrough pain.  I don't like the meds, the pain is not disappearing and I don't feel as if I am involved in improving my back's health.  Are there any books that deal with exercises that can be preformed by someone with thoracic problems, cervical and lumbar? (The surgeon of few words told me he was going to operate on my C and L spine after the T spine hence the request for exercises for C/L)  Could I do Pilates? I have trouble walking, I'm afraid even a treadmill might be too much.  I'd really appreciate your opinion on anything.  I'm starting to wonder if existence is life?  I very tired of dealing with this constant reminder that I have a back and thorax.  The surgery actually affected a nerve in my heart.  At times I will feel a sharp pain in my heart upon exhaling during meditation.  Sorry for the length of this saga and its disorganization.

Sincerely,

Maureen Martinek

ANSWER: Hello, Maureen,

All this simplifies down to a few points:

The universal response to injury is reflexive, protective muscular contraction that commonly outlasts the healing process and causes symptoms of its own:

* muscular pain
* vertebral compression
* vertebral displacement (which would account for cage shifts)
* formation of bone spurs or bone growth at the sites of muscular pulls (stenosis)
* stiffness

Your falls may have been sufficient to induce cage shifting and further muscular reflexive contraction.

Surgery is a partial solution that does nothing to address the causal muscular component.  If neuroforaminal stenosis (closing of the hole through which nerve passes) is a problem (and not merely a harmless artifact), surgery can help that.  That's all I can say on that topic.

Pilates is not a good answer, as it cultivates muscular contraction (supposedly balanced, but contraction, nonetheless).

Likewise, to strengthen abdominal muscles is a misguided effort.

article:  http://www.somatics.com/psoas_Q&A.htm

I recommend somatic education (not a mental process, but a training process for freeing muscular activity).  There are clinical practitioners and self-help programs (see http://www.somatics.com/practitioners; http://www.somatics.com/page7.htm - self-help).

Whatever else you do, my opinion is that you will substantially benefit from somatic education, which is more sophisticated than most physical therapy.  That's the short-list of options.

my articles:

http://www.somatics.com/recover_from_injury.htm
http://www.somatics.com/chronic_back_pain.htm
http://www.somatics.com/back_pain.htm

The articles are concise and easy to read.

Your doctors' words are alarming.  The reality is that by methods outside their scope of practice (somatic education), you can get substantial improvement.

If you feel I've left certain important questions unanswered, contact me, again.  OK?



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

QUESTION: I do have a question I'm not sure if I asked:  What is your opinion about the pedicle screw and my aorta.  (This refers to the fact that the tip of the screw and my aorta, if not touching, are so close that there is no light visible between them on the CAT scan. As the drs' response upon seeing the film was 'Wow', I now wonder what he meant) I've been suffering from very odd abdominal and thorax pain for about five months.  Any GI problems have been ruled out. I have my GI dr a copy of the address of the following, but he wasn't very interested.  Here is the address of the paper by some German surgeons who operated on a woman's back and she consequently had the screw infiltrate her aorta.

http://resources.metapress.com/pdf-preview.axd?code=821r7p8147744p68&size=larges
 
The drs actually admit that the woman had complained of odd abdominal pains for about a year (the tip of the screw had pierced her aorta). I couldn't see the entire paper, just the abstract, so was unable to read the description of her abdominal pain)I not sure what type of specialist I would see to rule out this possibility (and my surgeon's snide attitude leaves him totally out of the 'line-up').  I want to have this ruled out.  Any suggestions?

Thank you once again.

Sincerely,

Maureen Martinek  

Answer
Hello, Maureen,

Since you've asked my opinion (on a subject outside of my professional expertise), I'll give it.

I am not a surgeon.  But reasoning suggests that the tip of a screw near ones aorta can't be "good."  Witness your doctor's "candid" expression upon seeing the film.

As doctors may be reticent to express an unfavorable opinion of one of their own, and may instead close ranks, I would suggest contacting an attorney specializing in medical malpractice for a referral.  Then, get an evaluation of the film, not of the radiologist's report, by an impartial radiologist.  An ounce of prevention is worth a pound of cure.

You may then have something to communicate to your surgeon (and GI doctor) and some clout to back it up.  Your surgeon's indifferent behavior is unprofessional, as is your GI doctor's; they need (and their patients need) a change of attitude (which may be based upon fear of litigation).  They must either rule out any danger (in writing) or correct what needs correcting.

As I said, an ounce of prevention is worth a pound of cure.