Dr. Hackman Surgery 2/28/22 + Full Story

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Hi @Msdstc,

I just had surgery with Dr. Lo a month ago and I think I know what your talking about, but I got a totally different interpretation.

During my presurgical discussion with Dr. Lo he went through all the possible outcomes from surgery and like a good surgeon told me about his negative experiences. He mentioned that he has being doing C1 resections for quite a few years and had previously done them with a different neurology and hospital group. One of the neurosurgeons in the group (not Dr. Lo) was doing a C1 shaving and hit an artery. I am assuming he cut into the C1 bone too far and hit the ICA. The patient lost a lot of blood, but was stabilized and fully recovered.

Because of that surgery, Dr. Lo told me he has a different surgical approach that makes it impossible for him to cut into that artery. I didnā€™t ask what, because I had already burdened him with a thousand other questions and that wasnā€™t even on my radar. However, in my surgical notes it mentions the use of doppler to find the location of the ICA. So this is just me putting the puzzle pieces together, I think he has a doppler constantly going during the C1 resurfacing to measure how far away he his from the ICA.

Maybe he has other tools, like a Piezo surgical unit. It makes it almost impossible to cut soft tissue when cutting through bone. The surgeon I work for uses it to avoid cutting nerves during his facial surgeries, but it can be used for arteries and veins too. I need to ask Dr. Lo on my next consult.

I appreciate you coming back to give us an update on your surgery progress. Your story is one that I followed the whole way through and reread in consideration for my own surgery. I am sorry that your surgery did not result in symptom relief and would love to see the updated MRV to look if C1 is what is still causing your compression. I really do hope that you can work towards a resolution whether its another surgery or something conservative.

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This is right and I did ask some C1 trimmers how they avoid injuring the Vertebral Artery and one of them told me they use ultrasonic bone scalpel which cuts bone but does not cut any soft tissue such as artery or nerve. This is how they now operate on the spine to remove bone and spare the spinal cord or nerves. The old tools were too risky.

https://www.google.com/search?q=ultrasonic+bone+scalpel+cervical&rlz=1C1GCEB_enCA1015CA1015&biw=1280&bih=625&tbm=vid&ei=Eq2MZI_ROOKH0PEPvcKN6Aw&oq=ultrasonic+bone+scalpel+cervi&gs_lcp=Cg1nd3Mtd2l6LXZpZGVvEAMYADIFCCEQoAEyBQghEKABMgUIIRCgATIFCCEQoAE6BQgAEKIEOggIABCJBRCiBDoICCEQFhAeEB1Q-gdY9hBgjRloAHAAeACAAZ4BiAHmBpIBAzAuN5gBAKABAcABAQ&sclient=gws-wiz-video&safe=active&ssui=on

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Fantastic info, @KoolDude! Thanks for the link!!

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You are welcome. Here is good one. They use it to peel an egg shell and spare the membrane of the egg yolk to illustrate how they avoid injury to the soft structures.

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Hey everyone. I realized that it may be helpful for a detailed update, now that I am 18 months post-op. So, here goes!

Firstly, Dr. Hackman is a truly outstanding surgeon. His bedside manner is wonderful, he truly cares, and my only longterm issues from the procedure is some chronic tightness near one of the incision signs into the platysma near the anterior scalenes. I have zero regrets with putting myself in his hands from a surgical standpoint. My scars healed great. His aftercare was great.

That being said, if I had to do it over again, I would NOT have followed through with the surgery. Truthfully, I have continued to learn an extraordinary amount about the head/neck/nervous system as I have continued to pour into my recovery, and I can say that I donā€™t think my calcified and overgrown styloids were really the problem.

On specialized imaging in NY with a cervical spine expert named Dr. Scott Rosa, I found that I have 12 injured ligaments in my cervical spine and craniocervical junction. This was causing CSF to not flow properly, misalignments of my C1 (atlas), jaw, and many other areas as well. This also caused fluid build-up in the ears, issues with my TMJā€™s, etc.

My working theory is that my styloids overgrew and calcified as a means of the body trying to adapt and stabilize the head/neck area, as I had significant injuries in these areas (history of high-velocity chiropractic adjustments, as well as sports injuries, though I believe high-velocity neck adjustments is the main cause of my injuries).

In my case, while the removal of the styloids took some of the pressure off of the IJVā€™s, it did NOT help my stability at all, in fact it made my head/neck/jaw MORE unstable. For anyone who suspects neck injury or instability, you may reconsider styloidectomy. The jaw is partially stabilized by the stylomandibular ligament, which also gets cut during the surgery. The jaw and atlas have a unique correlation when misaligned, and one can often make the other worse.

Since my styloidectomy, I have received 3 stem cell treatments into the injured areas, and have seen moderate improvement in many of my symptoms. I have also worked with another physician who performs nerve hydrodissections of the cervical plexus and brachial plexus, both of which were part of the equation in a lot of my symptoms (that I initially thought were due to the styloids, but were really a result of the instability). I have also received PRP into my left rectus capitus major muscle, which was partially torn. This was done under the care of one of the best live ultrasound/orthobiologic physicians in the world, who is in Montana.

These procedures are PRICEY, but effective in my experience. I was lucky to have the means to pursue the treatment.

I also found an extraordinary holistic practice in Indianapolis, IN (I donā€™t live in Indiana, but was willing to travel), who I have worked with for the last 90 days to figure out more root cause issues, and to assist in healing. I have made more progress with regard to symptoms in the last 90 days than the previous 18 months (before that) combined.

We found that I had numerous imbalances internally (hard to say whether this led me to be primed for a neck injury, or if it was a result of the neck injury, having led to these issues).

When I showed up on the first day, I was told I was the 3rd worst patient heā€™d seen in over 30 years from a structural standpoint. My atlas, jaw, ribs, sacrum, pelvis, feet, and skull (yes, skull) were all misaligned and adjusted using sound percussion (no bone popping here) and pinpoint lasers/vectors/special imaging. We then did incredibly detailed labwork that showed parasitic infection, heavy metal toxicity, gut dysbiosis, nervous system dysregulation (my body was stuck in sympathetic nervous system, probably from 2+ years of chronic pain and illness).

I will add that I have zero affiliation with the stem cell doctors at Regenexx, nor those at Holistic Integration. This is just my experience.

I am still somewhat disabled and working through all of this as best I can, but I did want to share that I have made some improvements with regard to tinnitus, odd visual issues, dizziness, POTS, etc. If I had to put a percentage to it, Iā€™d say itā€™s likely 35-40% improvement.

Iā€™m going to continue to work with the (3) doctors I am seeing, which includes the holistic doctor with whom I have seen the most progress.

In summation, though, I donā€™t want to talk ANYONE out of this surgery if you feel like ES is your main issue. It just so happened that it wasnā€™t my main issue, despite the abrnormal finding of overgrown and calcified styloids.

Dr. Hackman is incredible. I just donā€™t think this was the right path for me on the back end.

Hope this is helpful!

Dobbs

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Hi @Dobbs , thanks a million for the update.

Iā€™ve been following your case (and Iā€™d love to hear more updates as you go with your investigation and treatment), as Iā€™m not at the end of my own journey yet too.

My surgery (same Dr, same procedure, a year ago) solved horrible pressure headaches (most likely caused by compressed IJVs), but other things went really interestingly.

After coming round, I had that a-ha moment. Everything got resolved or almost resolved, from tinnitus, neck pains, neck mobility, brain fog, GI, vision improved, hearing improved, circadian rhythm became like a clock, and whatā€™s most important, the whole head/spine couple feltā€¦ ā€œnormalā€. Free. Unrestricted, well-aligned, and well oiled mechanism.

But that a-ha lasted about a week until something snapped in my neck (it would often happen before the surgery) and all the gains, except the headaches, almost instantly were lost, close to the pre-surgical levels. Overall they are better, including fatigue and brain fog, but not much. Various physical exercises help me keep my neck and shoulders more mobile and less painful than pre-op too. Tinnitus, perhaps, is worse than pre-op. But likely it wouldā€™ve deteriorated without surgery even faster.

I have long suspected that my case isnā€™t limited to ES too, and more similar to yours, with the overgrown styloids being the result of something else. In my case they eventually started compressing IJVs and causing unbearable headaches that needed to be taken care ASAP, but other symptoms might have been related to other causes.

So thanks for your update again, your information is very valuable for others (including me).

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Iā€™m glad that youā€™re seeing improvements, even if ES wasnā€™t your main issueā€¦sounds a very expensive and time consuming process, but years of issues I guess take a long time to resolve, at least progress is being made. Thanks for the update and for the info about whatā€™s helped you, weā€™re seeing more members with complex neck issues so itā€™s good to know there are treatments which can help! Best wishes, & I hope things keep improving for you :hugs:

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Greetings and I hope everything is in order again. After some time after the surgery, did all the symptoms improve and if so, by what percentage?

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Aleana - I included that info in my most recent update! Hope itā€™s helpful!

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To all who comes across this: for anyone else who has had bilateral styloidectomy surgery, do you also deal with muscle compression in and around the ears, TMJ, SCM, area. Obviously some is to be expected, considering the fact that part of the anterior neck stabilization and jaw stabilization systems are cut when the styloids are completely resected, but I am wondering whether this is more from my ligament injuries from cervical instability, from the chronic GI issues I am trying to recover from, or if anyone else who has had bilateral styloidectomy is also dealing with some muscle compression problems.

Thanks in advance for any answers (and hoping you all tell me that itā€™s not an issues for you)! Iā€™ll be sure to shoot another update in the coming months.

Cheers!

Dobbs

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There is some tightness left, though it got much better after all sorts of conscious neck movements, stretches etc.

Though what I noticed, I remember when I was younger, I had better proprioception from all the muscles holding my head upright, as now itā€™s harder to tell my headā€™s position and orientation in relation with the neck, with my eyes closed. Possibly it was coming from those now missing muscles. Itā€™s subtle, but itā€™s noticeable. Perhaps I need some sort of neurovisual/vestibular training to better employ my eyes and vestibular system so that they could compensate. Or maybe itā€™s something coming from the vestibular system, though I have less issues to tell my headā€™s position and orientation in space.

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@Dobbs,

Many of our members, whether theyā€™ve had bilateral or unilateral surgery, have commented on tightness in the area around their incisions both skin & muscle. If you havenā€™t tried this, gentle massage w/ your finger tips can help. Use something lubricating like lotion or body oil on your fingers so they glide across the skin & muscles. Additionally, getting some PT help or doing some gentle exercises to stretch the tight muscles can help, just remember, it can take some months for things to feel less tight & more normal. Itā€™s not a quick process.

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Yes, my muscles and the scar still get tight & need massaging every so often, 7/8 years after surgeryā€¦

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Hey Dobbs, Im not sure if you still keep updated on this forum but if possible can we chat. They found I have a Broken Styloid Process off the base of the skull and Im extremly nervous about surgery and amd wondering about alternative methods before i fully commit to my surgery date.

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@Cdbruce have been following a bit your story, how do you know that the styloid is broken and just not calcified on the ligament. Really curious if you have any pictures of your scans etc.

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Hey, Yeah I mean I had a CT or CT IAC the one that gives a 3D model and its obivous its broken off the base of the skull. That being said it took someone who either cared enough to look at the scans itself and not just read a radiology report. Or it just took a trained eye. Went through 6 previous ENTS who did not catch this so it just makes me wonder why they didnt catch it. Theres a tiny slither still connected on the base of the skull and according to Dr. Hackman its out of place and twisted. Im terrified to have this Surgery if i go though with it, so im wondering if my main issue can be targeted. Without removing rhe styloid. I think its one of the styloid muscles that causeing my main issue so if that can be figured out ill prefer just to remove the muscle and not the process.

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My main question is how do you differentiate a broken styloid from a calcified ligament, is it the fact its twisted out of place and also hanging on slightly? Reason why i ask is because i have really similar symptoms, including the neck crunching, pain etc, tinnitus as well.

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The differance is clear on the scan I think. So the broken Styloid you can tell cause if you compare one side to the other side there will be a break on the scan. Where the break is located there will be a black line like a void theres nothing to be shown then a picture or two later the section of the styloid will reappear and shows white on the scan. The calcification im assuming is the styloid itself, so when the styloid is elongated the process itself is over calcified leading contriction of the various stylohyiod mucsles leading to the hydoid. Thats why you see some they are calcified from the styloid to the hyoid bone itself. That entire length is considered the calcification. The Styloid even at the normal length is a calcified part of the anatomy in the first place. Im still confused myself but thats how I understand it.

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@Cdbruce - Since the pain caused by the styloid is due to nerve irritation, I donā€™t think getting a muscle removed will end your symptoms since youā€™d probably find that there are other symptoms beyond just the muscle pain you feel once the muscle was removed. The source of the pain/symptoms needs to be removed to get real recovery.

I really believe that youā€™re at an advantage with the location of the break in your styloid as itā€™s already removed from the skull base so all Dr. Hackman needs to do is remove it from your neck. He wouldnā€™t need to cut it off the skull base like he would if it was fully attached. That perhaps would make the surgery a bit easier.

Most of us were very nervous, scared, concerned about having ES surgery before we had it done but are incredibly thankful we went through with it because of how good we feel now.

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@Dobbs,
Can you tell us who the guy is you wrote about? ā€œThis was done under the care of one of the best live ultrasound/orthobiologic physicians in the world, who is in Montana.ā€
Thank you
happybear

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