Back again.....
 

As it’s been many moons since I last visited the forums, I guess I should (re)introduce myself to the gang around here.

My name is Alan, and I’m a 45 year old who has been dealing with spinal issues for many years. Back in 2003, I was involved in a pretty significant MVA. Walked away from it intact (just slight cervical whiplash), but the fuse has unknowingly been lit on a ticking time-bomb. In 2007, while on active duty in the Navy, I badly herniated L5-S1 (L). Was shipped back to Walter Reed (from Japan) for a discectomy with one of the Army’s top neurosurgeons (Dr. Michael Rosner). While I had decent initial results, the index level re-herniated within a year. Since that point, I’ve run the gamut of virtually every conservative treatment out there…..physical therapy, massage, traction, fluro-guided injections (ESI’s, nerve blocks, facet blocks), prolotherapy, PRP, acupuncture, chiropractic…..you get the gist. Though it all, I’ve managed to stay “stable” and “functional”, while I continue to experience periodic residual symptoms (and have never really gotten back to close to my standard of “normal”).

Fast forward to this year, and I’m now confronted with neck problems for the first time. Just after the new year, I woke up one morning with slight numbness in my right thumb. While it persisted for a couple days, it dissipated before I had cause for concern. Toward the end of the July/early August, however, I woke up with what I thought was a tight trapezoid. Assuming I’d just “slept on it wrong”, I went through the usual assortment of stretching I’d learned over the years. Unfortunately, not only did things fail to resolve, they have gradually increased over the following months (beginning to radiate down into the shoulder and arm). The base clinic (where I was stationed on reserve orders in Germany) didn’t really do much more than toss me some motrin & flexeril, sending me to physical therapy as a perfunctory gesture. While there, I went through a bit of dry-needling (something I’d had following hip surgery in 2014) and given the standard battery of stretching/strengthening exercises. No imaging (of any kind) was done, though it was acknowledged that I had some sort of “nerve impingement” (gee, thanks….really!). Coming off orders the end of September, the Navy (and military medicine) pretty much washed their hands of me….giving me round of prednisone, gabapentin, and some hydrocodone (referring me to the VA).

Now that I’m back to being a civilian, I have my choice of the VA and Blue Cross (though my “regular job”). The former has already declined to even offer and x-ray, despite the clear progression of my symptoms (“call me in a couple months if things don’t improve”….gotta love it!). Getting ready to head to my primary care doctor tomorrow, in hopes I can get THEM to authorize some sort of imaging…..so I can figure out just how bad the damage is. In the meantime, I’ve seen my wonderful chiropractor a couple times already, and she’s doing everything she can to keep me in one piece. Initial goal is to loosen up some of the immobility in my neck, using gentle ART and dry needling during our sessions. She wasn’t initially too concerned about the immediacy of things (from a surgery perspective), but 1) determined that C6/7 is clearly the “worst offender” (though C4-C7 are all affected), 2) acknowledged that there is at least a bulge (quite possible herniation) and 3) noted that there is a decrease in grip strength in the affected hand (the right, my dominant). While I was averaging 50-ish psi with my left on the dynamometer, the right was down just under 40psi. From what she advised, the dominant is typically 2-3psi HIGHER than the non-dominant….indicating there is clearly an issue.

So, where does this leave me now? Well, while I don’t relish the thought of more surgery, knowing enough about the way spine issues work (from years of reading), I really don’t want to lose the remaining quality of life I have (especially with tweens in the house, and me having JUST returned home). It’s clear that I’m now in a game of balancing conservative treatment (in hopes of “healing”) with taking the plunge to “fix” the problem. I have ZERO interest in a fusion, which I’ve steadfastly avoided over the years whereas my lower issues have been concerned. Had done quite a bit of research into lumbar ADR’s, so I’m pretty familiar with how their development (and the growth of “medical tourism”) is concerned….a function of the FDA slow-rolling promising designs. Now, as I shift gears into considering the possibility of a cervical ADR (maybe more than one?), I’m hoping to learn from those on here who’ve been through the experience. I will obviously have to await some sort of imaging to get an idea of where things really stand, but any feedback/guidance you (collectively) might have would be GREATLY appreciated. Ironically, I was just in Stuttgart for a year, which would have made the logistics of potentially getting this done MUCH easier/cheaper….but now will be stuck both paying out the nose AND having to travel a great distance (if it comes to that).

Thanks, and very best regards!
Alan the squid

Alan,

Go to an in-network spine specialist, tell them your symptoms, and get an MRI and x-rays. Screw the VA. After that, you'll get a diagnosis. If they recommend surgery, go see another doctor (bring your MRIs). If they also say surgery, start looking into who does ADRs (preferably Mobi-c's or Prestige LPs in case you need a two level). If both say no surgery, find a GOOD physical therapist and see if that helps. Mine helped me a lot. Computer work is my core problem, as of late.

There is absolutely no point in suffering these days. If you're in pain and can get an ADR, do it. I'd only suffer if ACDF was the only solution.

If you need three levels, then you could start looking into overseas with Dr. Clavel (but expect to pay out the ***).

Stay strong, friend.

If you have a GP you work with regularly, you might even approach them to authorize the imaging.

It's even a real long shot but occasional imaging centers can handle self-pay and offer a discount for not having to file insurance. If you can find one that's willing to go that
route, you don't need a doctor to authorize the imaging to get insurance coverage.

You might even be able to find an overseas doctor whose website or standard list of instructions for a consultation requests imaging and use that together with the self-pay to get an imaging center who's willing to work with you to just get the work done. You don't necessarily need to tell the imaging center that you've not been in contact with the overseas doc yet but leave them to assume that you have.

Update....
 

Thanks for the feedback! With my symptoms continuing/progressing, and my civilian insurance with Blue Cross FEP having started back up (as of 1 October), I did an end-run around the VA (useless, as expected) to obtain imaging of my neck. After seeing me last week, my primary care physician ordered a c-spine xray series, and provided a referral to have an MRI (without contrast) done. As I expected, the former didn't really show anything of relevance, merely confirming there were no breaks (shocker). Went for the latter on Wednesday evening, and have already received the official read-out (though I had a pretty good idea from the CD they burned for me what was going on). According to the report....

The cervicomedullary junction and the cord appear normal in signal, without evidence of Chiari I malformation. The vertebral body heights are normal without acute fracture. There is no evidence of acute inflammatory facet athropathy. The marrow signal intensity of the bones are normal.

Multi-level mild disc degeneration is noted.
Segmental analysis as below:

At C2-C3: No herniation or stenosis
At C3-C4: No herniation or stenosis
At C4-C5: Minimal disc osteophyte, unchanged
At C5-C6: Minimal central canal and bilateral foraminal crowding, from osteophyte, unchanged
At C6-C7: Mild disc osteophyte, unchanged
At C7-T1: No herniation or stenosis

Impression:
No evidence of focal disc herniation, with degenerative changes as noted above.

This is pretty much in line with my (layman's) read-out of the MRI images... having looked at enough of these over the 10+ years of my lumbar issues to understand lateral views. It's also pretty consistent with the last cervical MRI I had, back in January (when I first noticed some numbness in my right thumb...which eventually faded). That said, my symptoms are much more pronounced at this point, and have become gradually worse over the past 4 or 5 weeks (to the point I'd almost consider surgery IF it is an option).

The one curious thing I noted from the official read-out was the mention of osteophytes at several levels....verbiage which has never appeared before. Is this something of immediate concern, especially given the fact that I'm much more symptomatic than at any point earlier (increased pain in my neck, radiating down my shoulder in the arm....as far as my elbow...coupled with increasing tingling in most of my fingertips)? As this is all new for me, any thoughts would certainly be appreciated....

Laying down
 

I bet you were laying down for the MRI? It amazes me cause in my case I felt best when lying down.

Yep, I was in the tube for the MRI, though laying down doesn't really seem to matter too much whereas my symptoms are concerned (especially if I'm laying on the affected side). Truth be told, while MRI's are pretty easy for me (been through far too many of them), laying still on my back that long was actually more aggravating to my lumbar issue/sciatica than my neck itself. Just can't win....D'oh!

Pain
 

What I was getting at was gravity affects the spacing on your verts while lying down your really seeing the best case scenario as far as separation goes also when the pressure is off the discs relax somewhat

Dude, you're good to go with that MRI. Everyone will develop osteophytes overtime. I mean look at my MRI in my sig... I'm 32 (mine came from an injury when I was 20, but I am still not ready for surgery).

You're probably having referred pain from trigger points. Go to a good physical therapist, exercise, move around a lot if you have a desk job, and stop worrying about it. Also don't text with your neck down.