Sunday, November 6, 2011

A Hey Clinic Guest's Story of the Mysterious Spinal "Clunk"

I received this write up from one of my patients this past week. As she says- -- I had never seen anything quite like this before!!   I think you will all enjoy it!
Things have been very busy as Hey Clinic routine.  I did two surgeries yesterday on Saturday, but thankfully was able to catch my breath and enjoy the beautiful North Carolina fall weather today.  

Hope you are all doing well.
Dr. Lloyd Hey — Hey Clinic for Scoliosis and Spine Surgery —


My Back Story:  Susan

In early 2010, I didn’t consider myself as someone with “back problems”.  Sure, my back would feel tired if I stood for a long time, but I figured that was just a part of being on the high side of my 40s.

In March 2010, I leaned over while sitting at my desk to adjust the small heater at my feet, when I felt something wierd.  There was no pain, no noise, but a feeling that I almost got stuck in that twisting, bent over position.  It was fleeting, so I didn’t give it much more thought, but it felt strange enough to be memorable.  

In the following couple of months, I developed a random “clink” sound in my back when I bent over to reach something in a lower drawer or off of the floor.  This “clink” was a precursor of the “clunk” that developed soon after.  It was a loud clunk, but it occurred randomly in the spring of 2010.  It was loud and uncomfortable enough to mention to my rheumatologist during a routine visit in late May.  I described it as occurring in my mid-back and I wondered out loud to him if it could be related to my RA.  I was confidently told that it very likely was NOT RA-related since the thoracic part of the back typically isn’t affected by RA.  I was not able to reproduce the clunk during that doctor visit, but he ordered an MRI to evaluate it further.  

My insurance company agreed with me that this seemed to be coming right out of the blue.  So much so, that they opted to cover a flexion/extention x-ray rather than MRI.  These x-rays showed displacement as I bent over and arched back.  

By this time it was June/July.  The clunk was much more consistent and louder and generally more “violent” for me to experience; along with a noise, I experienced a jolt-type sensation with the clunk that seemed to shake me right through my legs, with knees buckling, giving me an instant’s sensation of my legs giving out on me - though I never actually fell down, it seemed darned close a time or two!  The noise was loud enough for others to hear from another room.  I would be dressing in our closet when my back would clunk and my husband would ask from the kitchen table “Was that you!?”.  In July, I was able to get an MRI to further evaluate what in the world my back was doing.  Through all of the evaluations, it was noted that it was a pretty strange level of my back to be having problems.  The instability demonstrated on x-ray was at T10-T11 rather than in the lower back region.  It didn’t seem too strange to me, since that was the area where I always experienced aching and tiredness when I stood for a long time.  

By August, I had about had it with the clunk!  It seemed to be progressing at a pretty good clip in terms of how loud it was, how often it occurred, how it seemed to shake through my whole body.  And then I began to have an odd pain in my lower ribs; like someone was stabbing me with a knitting needle verrrry slowly.  No change in position would alleviate that pain.  Finally, when I met with my rheumatologist to review the back MRI results, we chose to explore surgical consultation since I additionally described vague urinary symptoms of feeling the need “to go” recently after using the bathroom (and ruling out UTI).

By August, the clunk would occur with laughing and sneezing as well as with forward bending, which I tended to avoid at this point.  Fortunately, I learned how to make my back clunk “on demand” so that the doctors could witness it:  I would distract myself by pretending to bend over my purse to get something out of it.  It worked every time!

I met Dr. Hey in September 2010 and was able to demonstrate “The Clunk” for him with the purse trick.  By this time, my mid-back would not only clunk while bending forward, but clunk again while straightening back upright again.  Ewww!  It was all very uncomfortable!  

I was relieved to learn that though Dr. Hey readily stated that he had never seen anything like my condition, he was very confident about how to correct it and offered a detailed explanation with a visual model that helped my husband and me understand exactly what he offered to do for a surgical repair of this awful clunk.  I was absolutely ready to do what was necessary to eliminate this quickly progressing problem and Dr. Hey was the surgeon to do it.  We immediately made arrangements to schedule this for the following month and voila!  I haven’t “clunked” since, nor had any other creepy pains or problems!  

In terms of thinking about how or why this occurred at this unusual level of my back; I have a theory that an old injury that was never evaluated became aggravated by age.  When I was in sixth grade, while doing intramural gymnastics, I was doing multiple back handsprings in a row.  I was in “the zone”!!  I could’ve done back hand springs all the way home!  Except I realized that I was probably fast approaching the end of the mat and had no confidence in my co-sixth grader spotter to let me know that.  When I had that thought, I over arched my back in an attempt to have my hands land on the mat.  Instead, my fingers hit the back of my legs rather than the floor and I hit the floor with my chest with my legs over my head and kind of “sproinged” my back in that arched position.  The fall definitely took my breath away, but I felt silly for causing this and immediately jumped up and acted like I was fine before the coach noticed my boner of a fall.  No specific injury ever occurred from that fall.  I didn’t hurt enough to let my coach or parents know what happened - ever.  But I can’t help thinking that any slight damage from that fall could have made that particular thoracic level be the “weak link” to cause problems later in life.  

Now, thanks to Dr. Hey, the top half of my body is securely attached to the bottom half!  All is well healed and no more problems!

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