• Your Name
  • Your Phone Number
  • Your Email Address
  • Please Describe What Happened

Back and neck injuries

Lumbar (back) and cervical (neck) injuries are the most often diagnosed injuries in vehicle accidents. Obviously these can range from minor injuries to very major and catastrophic injuries. Most injuries in vehicle accidents are to the neck because of the weight of the head being thrown backwards and forwards. These are sometimes referred to as flexion extension injuries. Although seat belts do prevent certain injuries to an extent, they are most definitely not intended to be failsafe protection against all spinal column injuries in vehicle accidents. Even with the seatbelts, if there is slack in the shoulder harness, the body can be thrown forwards in a jackknifing effect, thereby causing injury to the back.

Typical neck or back injuries include: fracture of a vertabra , fracture of the spinous process, fracture of the transverse process, fracture of a pedicle, subluxation of the articulating facets, rupture, bulge, protrusion or herniation of a disc,  sprain, strain, torn or stretching of muscles, ligaments or tendons. Unfortunately, there is no standard nomenclature for injury to the discs. What one orthopaedic surgeon might call a rupture might be called a protrusion by another orthopaedic surgeon.

There are generally 24 vertebra in the body, 7 in the neck, 12 in the thoracic (mid back), and 5 in the lumbar area. Any of these vertebra are capable of being injured in a vehicle accident. Basically, the higher the injury, the closer to the brain and the more serious it can be. Similarly, the lower the injury the more serious it can be because of possible added complications. Any herniated disc is significant, especially if the disc impinges on a nerve. The ligaments attached to the vertebra help hold the vertebra in place. If these are damaged in an accident, there can be instability allowing discs to move and possibly press on a nerve. Often, when the ligaments are torn they heal with scar tissue which is not as elastic as regular tissue. This can cause permanent injury and permanent restriction of motion. The disc space that is most vulnerable in a vehicle accident is the lumbosacral joint because it is the joint between the fixed vertebra below the sacrum and the moveable vertebra above the sacrum. For example, because of the size of the weight on this joint, it can suffer substantially more than a knee joint for example. The nerves that come from the 5th vertebra are larger than other nerves coming from other vertebra. This means they are more susceptible to injury as well.

For the most part, the nerve openings are larger the more one goes up the spinal column. Therefore, nerve impingement may be more likely in the lower vertebra of the lumbar spine.

There are discs between each level of vertebra. These discs act as cushions for any shock or movement to the spinal column. If there is injury to the disc, there can be many results, most of which are harmful to the health of the individual. For example, the client can have disc space narrowing which would provide less space for the exiting nerve. The spine might become far less mobile. The shock absorber effect can be decreased or eliminated. The disc material itself can harden and cause spinal stiffness. The normal anatomical relationship of the supporting structures (tendon, ligaments, muscle) can be affected causing muscle spasm.

The single largest nerve in the body is the sciatic nerve. Since this nerve supplies the lower extremities, any injury to the sciatic nerve can be very painful and problematic. Injuries to the sciatic nerve can affect walking, running, bending, sitting, kneeling and lifting any heavy weight.

It is important to note that a regular x-ray will not demonstrate any disc involvement. X-rays basically show bone, not disc material. If the disc is to be observed, the gold standard for that observation at this time is the MRI. Operations on discs can cause additional problems as well to the integrity of the spine. Often, the level below and the level above the operative site are compromised to some degree where problems in the future could easily develop. Any trauma, however slight, can cause disc injury leading to very serious consequences. The discs have such load bearing responsibilities any compromise of a disc can be very painful and can significantly add to dysfunction at other levels of the spinal column.

X-rays may permit viewing of narrowing of the disc space at a particular level but not much more about the disc itself. A myelogram used to be one way a provider would determine if there was disc involvement with an injury. The issue with a myelogram, however, is that it is technically a surgical procedure because a needle is inserted into the spine and  dye is released into the space around the spinal cord. The dye is move up and down the spinal cord by tipping the patient up and down and then the provider views the various disc levels.

A CAT Scan is used to demonstrate as disc injury at times. This is a computer aided scan that provides cross sections of the body for viewing purposes. This test is much better than a normal x-ray as a diagnostic tool. The CAT scan seems to work much better at the lumbar level than the cervical level.

A magnetic resonance imaging (MRI) also creates significant detail and contains complex computer measurements that assist in the diagnosis of spinal issues. It seems to work better in the cervical region than the lumbar region. A magnetic field with the assistance of radiofrequency waves is used to create the desired image. There is no radiology involved so there is less danger to over exposure. This has become the gold standard for evaluating disc injuries, especially in the cervical region.

A technique sometimes used by providers to diagnose pain is what is called a thermography procedure. This procedure measures surface body temperature that supposedly assists the treating provider in diagnosis pain patterns. These tests have not necessarily been embraced by all physicians but chiropractors tend to use them mostly.

It is very important for the medical provider to determine if there is neurological involvement with any injury. The provider will attempt to elicit response to pin prick, stretching, or reflex tests, visualize atrophy or anything else that will demonstrate nerve root involvement. If there is nerve involvement, this would suggest a serious injury and one that might require surgical intervention, especially if the injury persists after initial swelling and inflammation subsides.

A treating physician is concerned about both the subjective complaints of his patient as well as objective findings he determines upon physical examination. Although almost all doctors will treat on subjective complaints of the patient alone, it is helpful to the ultimate diagnosis if there are objective findings such as muscle spasm, atrophy, tightness, range of motion problems or neurological deficits upon examination. Certainly, an MRI finding would be one of the more significant objective findings.

The standard course of treatment for neck and back injuries includes immobilization, muscle relaxants, anti inflammatory medications, physical therapy to the effected areas, traction, exercises, manual manipulation, reduced activities and use of a neck or back brace as well as injections if the injury warrants it. Each injury is treated somewhat different depending on the subjective complaints and objective findings.

In some cases, the treating physician may be asked by the experienced attorney to provide what is called a permanency rating. The American Medical Association has established guidelines for the evaluation of permanent impairment. These have traditionally been used in the worker’s compensation context but have also been widely used in the automobile accident context where appropriate. Essentially, by following the guidelines, the physician can arrive at numerical value to associate with the condition of the plaintiff. In addition to the factors used in the AMA Guide, Maryland has adopted what is known as 5 additional factors for a physician to use in establishing a permanency rating. These include pain, atrophy, weakness, loss of function and loss of endurance. With the combination of the AMA Guides and the 5 Maryland factors, the plaintiff can obtain a fair permanency rating.