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Cervical Neck Instability

Spine Health | Last Active: Mar 1, 2023 | Replies (48)

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@slw18

thanks for your advice. ive had neck issue from old accident, but the orthopedic doc didnt want to do much beside a xray of the cervical and the lower spine. didnt want to do the middle. he didnt want to persue anymore test. should i try another orthopedic? is a xray enough? can i got to a physical therapist before a diagnosis?

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Replies to "thanks for your advice. ive had neck issue from old accident, but the orthopedic doc didnt..."

@slw18 A physical therapist can help even if you don't have a specific diagnosis. You need a doctor to write a script for PT and check your insurance benefits. All you need is to have some pain or weakness, and it doesn't need to be a specific diagnosis. The PT will help with that. Research until you find a good one, and they should be willing to talk to you on the phone (at least briefly about your case) so ask questions. Call several in order to find one who is a good fit for you. They need to do an assessment and see imaging first as a starting point. They are also a good resource to know when you need to see a surgeon for possible treatment or surgery, but the goal of PT is to avoid surgery, and/or rehab after it with physical means. My PT certainly helped me with that, and even knew some names of local surgeons.

Since you have an old neck issue from an accident, your spine discs can be like mine were, with cracks caused by the trauma of the accident, and as you age and your spinal discs dry out, those fissures can open up and the wall of the disc weakens. I had imaging of my full spine before I had spine surgery, and it was necessary to know what levels of the spine could be generating symptoms. If your case gets into that territory, the doctors don't know and cannot rule things out unless they have imaged your entire spine. I wouldn't push for that at the beginning, unless consideration for surgery is discussed as the doc needs to justify the reason for the imaging to the insurance company. MRIs are pretty expensive.

@slw18 I would advise a consult with a spine specialist and a current MRI to determine your status. An X-ray does not show the discs, but it can show if the spaces the discs occupy between vertebrae are abnormal. In general, you can go to a physical therapist, but the PT should be asking you for a report of imaging if there is any question of spinal instability. If you have instability and the vertebrae can slide forward or back, you are at serious risk of injury or paralysis if someone works on your neck. It sounds like your orthopedic doctor does not want to take your case for any further treatment. Surgeons pick and choose cases, and they may avoid difficult cases because a poor surgical outcome can hurt their statistics of success. They are rated by insurance companies and don't want to harm their careers, so they refuse to help patients. They also refuse to help patients who they don't think they can please because they don't want bad reviews posted online. Sometimes they don't help people if they perceive a mental issue also because that patient will never be happy with the outcome. These are things I have heard a surgeon say when presenting cases at a conference for other surgeons and discussing patient selection. Do everything you can to be a good patient that surgeons will want to help.

You do need to find another doctor for another opinion. Spine surgeons like to refer patients to specific neurologists if testing is required, so it makes sense to start with a spine specialist. You do have an old injury, and spine problems from that can sneak up on you. You mentioned "electrical stimulation throughout the body". You might be describing the same symptom I had that was caused by spinal cord compression. When I bent my neck forward, I got an electric shock down my entire body. If that is what you have, You should see a spine surgeon ASAP. Choose your spine surgeon carefully. Some are gifted; some are not, so do your research and find the best you can. Check your insurance coverage and make sure they are in network. Spine surgery is very expensive. If you do make another appeal to get into Mayo, do that with current imaging of your spine issues directed to a spine surgeon or to the neurosurgery department. Your primary care doctor could order MRI imaging based on your symptoms for a referral to a spine specialist. There are orthopedic and neurosurgery spine experts and either can operate on the spine. I chose my spine surgeon because his areas of interest matched my case, and because when I read his papers, I knew he would understand my symptoms because it referenced leg pain caused by cervical stenosis (cord compression in the neck). Here is my patient story. Let me know if I can be of further assistance. I was turned down 5 times before I came to Mayo.
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/