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Fractured Spine , Atlanto-axial Joint Injection

Sunnie spine patient story back fracture walking outside with friend

Sunnie Baron-Freeman stepped off the curb and into the street. She never had a chance to see the oncoming car blowing through a red light. But her partner did.

He pulled Sunnie back just in time. But they both fell hard on the sidewalk. Sunnie, who was 80 at the time, was rushed to a nearby emergency room, where she was told that she’d fractured her spine in multiple spots. But, because of her age, she was deemed too high-risk for surgery.

Instead, she was referred to Adrian Popescu, MD, the director of Interventional Spine Fellowship and an assistant professor of Clinical Physical Medicine and Rehabilitation at the Perelman School of Medicine at the University of Pennsylvania. He resolved Sunnie’s pain, but his thoughtful approach made an even deeper impression on Sunnie.

A few years later, in 2016, after another fall, Sunnie began experiencing what she describes as a “bad toothache in the back of my head.” She returned to Dr. Popescu, full of confidence that he’d once again be able to relieve the pain that had ground her life to a halt.

“It was pretty unbelievable, and my pain threshold has always been pretty high,” Sunnie says.

A life-changing decision

Her “bad toothache” was in fact a fractured piece of Sunnie’s cervical spine pressing on a nerve. There was a spine surgery that could help, but it would likely result in total and permanent numbness across half of her head. Dr. Popescu, instead, began a “very conservative, non-aggressive” course of treatment in an effort to manage her pain.

“Knowing her anatomy and knowing how complex and delicate the area where the pain was originating from was, we tried to avoid high-risk spine interventions,” Dr. Popescu says.
But as a topical gel and then occipital nerve blocks failed to help, there was soon only one very high-risk injection left to try. 

An atlanto-axial joint injection entails guiding a needle a little thicker than the kind used for acupuncture to a one- to two-millimeter target at the top of the cervical spine by way of x-ray. Landing even a hair outside of this location could potentially cause a stroke, paralysis, or death. 

Once it’s confirmed the needle’s in the right place, a local anesthetic and a corticosteroid are injected into the atlanto-axial joint. The anesthetic temporarily numbs the pain and the steroid helps reduce the inflammation.

Asked how Sunnie’s age factored into her treatment—she was 86 at this point—Dr. Popescu says that it didn’t. “If my mother had the same problem, I would have done the procedure,” he says.

“With osteoporosis, my mom’s lost several inches of height,” says Sunnie’s daughter, Suzy Freeman. “Whenever we’ve met with Dr. Popescu, he’s always lowered his stool as far as it will go so that he’s at my mom’s eye level. And he takes her hands into his. He’s uncommonly warm that way.”

Sunnie, for her part, says she spent two long weeks mulling over the risks before ultimately deciding that she wanted the injection. “The pain was so bad, I thought if I died, at least I wouldn’t be in pain anymore,” she says.

The surprise ending

Sunnie spine patient story sitting inside Sunnie remembers laying on the operating table, wide awake but very still, her eyes not even blinking. Gradually, she became focused on one of her arms, which was folded in an uncomfortable position. When Dr. Popescu told her the injection was over, her first instinct was to move her arm. And as soon as she did, she realized she wasn’t paralyzed. 

Then came a second wave of relief when Sunnie realized the pain was gone, too. The injection is meant to work just that fast. But the fact that Sunnie remains pain-free three years later is unexpected. Several months without pain qualifies as a success in the best-case scenarios.

Sunnie’s recovery isn’t unprecedented, Dr. Popescu says, “but the only explanation that I have is that the steroid significantly decreased the inflammation in the joint and it just never returned.

“I’d be hard-pressed to say that everyone should expect the same result,” he continues. “But she did have a definite need for the injection, which is key. The patients who have a clear indication for a spine injection seem to do pretty well with it.”

Sunnie believes she’s done her part, too, by following all of Dr. Popescu’s aftercare instructions to a T. Well, almost all of them. It did take her a while to finally give up the jarring SEPTA bus rides.

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