Pre-Screening for Neck Surgery

Post-Cervical Whiplash or Cervical Trauma Patients

Patients who have sustained a whiplash injury or trauma to the cervical spine may be good candidates for surgical treatment. Please review the list of pre-existing conditions or qualifying factors to see if you would benefit from surgical treatment.

Coincident with the noted conditions, we may detect herniated cervical discs and lower cervical instabilities. These patients may be candidates for posterior cervical fusions at those levels or anterior cervical decompression and fusions to be discussed below.

Please note that this surgical program is NOT generally directed towards patients with Cervical fractures or permanent Spinal Cord Injury.

Pre-existing conditions or qualifying factors

  • Intractable Migraine Headaches and Tension Headaches
  • Headaches originating with Cervical or neck pain (Cervicogenic Headaches)
  • Neurological complaints as a result of Whiplash or similar neck trauma – collectively known as the Whiplash Associated Disorder or Cranial Cervical Syndrome (see symptoms)
  • Primary Migraine Headaches: In rare cases of Cervical Digital Motion X-ray (C-DMX) proven C1-C2 instability in the absence of trauma, patients with intractable migraine headaches unresponsive to medical/neurological treatments may be candidates
  • Arnold-Chiari Syndrome Type 1 patients are candidates for decompressive sub-occipital craniotomies, and if C1-C2 instability is present, they may be candidates for C1-C2 fusion.

Pre-screening Exams and Diagnostics:

Prior to referral to our center, you must undergo a thorough evaluation by a medical practitioner skilled in understanding the structure and function of, and trauma to the upper cervical spine.

These will include Chiropractic physicians, Medical doctors, Neurologists, Neurosurgeons and Orthopedic Surgeons.

Please feel free to ask your medical provider to refer you to our center.

The provider needs to send your medical records and a DVD disc containing your updated radiological studies.

In certain circumstances, in scheduling your consultation with us at our center, we may also schedule an updated radiological study on your arrival here. For example, studies that are many months or even years old will often not accurately reveal the current clinical situation

Diagnostics & Tests for Neck Injury

Several diagnostic studies are valuable in determining if you are a candidate for the C1-C2 fusion and sub-occipital decompressive craniectomy.

Cervical Digital Motion X-ray (C-DMX)
This is a low radiation digital fluoroscopic movie of the motion of your cervical spine. The purpose of this study is to determine if you have instability or abnormal excessive movement of C1 on C2.

The most important sequence of images obtained in this series, is the open-mouth odontoid view where you flex your head side-to-side without rotating your head. It is imperative you follow the directions of the person administering this test. This test will determine if you are a candidate for the C1-C2 fusion.

The DMX is most commonly available at select Chiropractic Physician offices, and at some Medical, Radiological, and Neurological offices.

Upright Positional Cervical MRI (CpMRI)
This study is an open MRI scan in which you are seated upright, as opposed to lying flat in the standard MRI.

The purpose of this study is to determine if one of several abnormalities is present in your cervical spine, making you a candidate for this operation. These include:

  • Ligament injury at C1-C2 explaining the instability present on the DMX study (Fig 3, Fig 5)
  • Cerebellar Tonsillar Ectopia (CTE) – the post-traumatic descent of the lower cerebellum in the back of the skull towards the spinal canal, compressing the brainstem and spinal cord (Fig 4, Fig 20)
  • C1 capsulosynovitis – an inflammation at C1-C2 causing a msaa that compresses the brainstem and spinal cord (Fig 4, Fig 20)
  • Herniated cervical discs and bone spurs called osteophytes

You will be asked to bend your neck in stressed positions, such as flexion, extension, and lateral tilting or flexion. In each position you must remain motionless while the scan is taking place.

Other useful studies
  • Complete cervical xray series with flexion and extension views
  • CT scan of the Cervical spine
  • In the absence of the Upright positional MRI, a standard MRI of the brain and cervical spine may suffice
  • Brain MRI scan: This is sometimes useful as an adjunct study to rule out a brain problem as the cause of the presenting symptoms. Typically, it is not absolutely necessary.
  • Magnetic Resonance Angiogram (MRA) of the cervical spine and brain, especially in the Upright MRI scanner. With stressed positions, abnormalities of spinal cord and brain blood flow may be seen.
  • Cine-MRI is a study available in only specialized radiology centers and can demonstrate disruptions of cerebrospinal fluid circulation in the cervical spine and brain

Resources for where to get pre-screened:

Your local health provider is your first resource for referral to the pre-screening radiological studies necessary to qualify you for surgery.

These include your chiropractic physicians, medical doctors, neurologists, neurosurgeons and orthopedic surgeons.

The locations of Digital Motion X-ray (DMX) and MRI centers – especially Upright MRI facilities – should be available on-line. We are in the process of assembling a list of such centers.

For chiropractic care in Florida, we recommend contacting Waterside Chiropractic.


 

Medical-Legal Consultations by Dr. Joel Franck

Medical-Legal Analysis

Dr. Franck is available for a medical-legal analysis of the whiplash case at hand. He will serve as either your “treating physician expert witness” or “independent non-treating expert witness”. Read More