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Dr. Chip
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 31224
Experience:  20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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I have had neck and head pain for three years. Plus some symtpoms

Customer Question

I have had neck and head pain for three years. Plus some symtpoms such as transient double vision, arm pain, dizziness etc. A physio sent me for an flexion and extension x-ray which showed mild cervical spine instability. The orthopeadic registrar who saw my x-ray recommended a neurosurgery consult. However my GP sent the letter to neurology rather than surgery. The neurologist saw it and doesn't believe I need a consult so has referred me to a headache clinic!

So I have an unstable spine, yet have had no further tests such as MRI's etc which I were led to believe were essential, even with the instability being mild as it could still lead to serious issues if not checked out further. It is on discs two through four that the instability was seen. I have had a couple of accidents including one two decades ago where I was knocked down and had head injury including concussion and broken cheekbone - my neck was never checked at this time.

Do you think the headache clinic is okay or do I need to ask for a spinal or neurosurgery consult once more?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

you can go to the headache clinic.

Dr. David :

but I think what you really need is a cervical spine MRI scan with contrast.

Dr. David :

and if that MRI scan of the spine shows spinal instability, severe disk herniation, pressure on spinal cord or nerves, then you definitely need to see a neurosurgeon.

Dr. David :

simple flexion and extension xrays of your spine does not see the spinal cord and nerves well.

Dr. David :

an MRI scan is needed to look at the nerves and spinal cord.

Customer:

This is what I was led to believe. But why has the neurologist downgraded my referral to a headache clinic? Could it be the orthapeadic surgeon thought the x-ray was more severe than it is and the neurologist thinks there is no instability? I can't speak to the neurologist to find out so will have to go back to my GP and demand more referrals and am worried my insurance will think I am being pushy if a neurologist thought it was nothing serious.

Expert:  Dr. Chip replied 3 years ago.
Hi--I'm a different expert. Your condition warrants the MRI--absolutely no doubt about that. This is probably a disk issue but it may not be a surgical issue so I would refer you to a physiatrist--a physical medicine and rehabilitation MD specialist--after the MRI for a customized treatment program that could well resolve your symptoms. There really is no place here for a headache clinic referral.
Customer: replied 3 years ago.

Thanks for your answer. I am in the UK and not sure we have physiatrists? Never heard of one. My physiotherapist has been concerned for some time. And I also have lumbar spine issues with sciatica and hypermobility in my knees and hips. She believes I need to see a rheumatologist to rule out any disorders leading to all this 'laxity' in my joints - and she believes I need the MRI as she says ANY evidence on a neck X-ray, even mild, is actually quite serious if it shows instability.


 


Sorry to ask again but could it be that the orthapeadic surgeon read the x-ray wrong and because the neurology consultant has seen it himself he believes there is nothing going on? Can x-rays be mistaken in this way?

Expert:  Dr. Chip replied 3 years ago.
Did a radiologist read and report on the x-rays?
Customer: replied 3 years ago.

An orthapeadic registrar read the x-ray at the hospital after I had it taken at a basic x-ray walk in clinic (on request of my physio who was concerned with my symptoms) and the ortho registrar wrote to my GP saying I needed a neurosurgery consult. My GP sent the referral to a neurologist consultant - not neurosurgeon - by mistake it seems. However they do work in the same building and the neurologists secretary spoke to me today and said if he'd thought it was relevant to neurosurgery he would have passed it to them. Instead, the neurology consultant read the referral and x-ray info from my GP and downgraded it to a headache clinic.


 


 

Expert:  Dr. Chip replied 3 years ago.
OK. Mild cervical spine instability really is not a very specific reading and it may really mean nothing much at all. You do have physiatrists in the UK and they are also known as sports medicine doctors. I think you need a full spine MRI to look for what may be multiple disk problems. An autoimmune screening with ANA, rheumatoid factor, sed rate, and C reactive protein is a reasonable start to see if you might need a rheumatologist but I think the major problem is a disk problem
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 31224
Experience: 20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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