In the majority of my personal injury cases, my clients have sustained an injury to their neck and/or back from a traumatic incident, whether a fall, a motor vehicle accident or other unexpected violent occurrence. Often times, my client has had no prior neck or back pain and are suddenly immersed in a world of multiple physical examinations, diagnostic testing and numerous treatment options. Having handled these claims for almost 25 years, I have gained an insight into both the mechanisms of injury which can cause permanent damage to the neck and back and the various treatment options which are available to minimize the pain and disability which can result.
Most spine pain experienced by my clients has resulted from injury to the discs which are located throughout the neck and back and provide cushioning during movement. The exterior is made up of a tough fibrous material known as the "annulus". The inside of the disc is comprised of a softer gel-like material called the "nucleus". While these discs are durable, over time, as a result of either the strains of daily living or repetitive motions, heavy lifting or even swinging a golf club, they can degenerate. This degeneration can often occur in the absence of any pain or discomfort.
When discs degenerate, then tend to flatten and may appear to "bulge" beyond the edges of the vertebrae they are intended to cushion. Discs can bulge enough to narrow the space through which the nerves to both the arms and legs must travel. This is commonly referred to as "spinal stenosis". Without more, stenosis can cause symptoms in the arms and legs, but when trauma is applied to the weakened disc, such as from a motor vehicle accident, the annulus may actually rupture, or "herniate", permitting a portion of the nucleus to push through the opening and put pressure on the nerves. This can cause immediate and debilitating pain in the arms and/or legs.
An MRI is the best way to diagnose the cause of the pain. Many times, the films reveal a traumatic herniation superimposed upon a previously undiagnosed degenerative disc. In such cases, the defendant's insurance company will often claim that the root cause of the pain is the degenerative disc which existed prior to the accident. It is the plaintiff attorney's job to establish, usually through the use of expert testimony, that it was the crash that "woke up" the previously asymptomatic disc and that the at-fault party is to blame.
The treatment options for back pain are numerous. Most clients rightfully pursue more conservative treatment such as physical therapy and injections before ever contemplating surgery. If conservative measures are unsuccessful, the client has a number of surgical options to consider, from the now popular "minimally invasive" procedures to more traditional surgery. Whatever surgery is performed, there is usually a difference in the procedure depending upon whether the neck (cervical) or low back (lumbar) is involved.
Because the cervical discs are smaller, they are more often removed, replaced with bone or other material and then the adjacent vertebrae are fused. Since the lumbar discs are larger, surgeons often only remove the herniated portion and are less likely to fuse the vertebrae together.
The doctors I work with in my personal injury practice all place a premium in educating their patients as to both the causes of their neck or back pain and carefully explaining their treatment options. While the ultimate treatment decisions are between them and their physicians, I can at least give them a framework for what lies ahead in both the courtroom and their doctors' offices. If you or a loved one has sustained a back or neck injury as a result of a motor vehicle crash or other traumatic incident and have questions regarding which doctors and treatment to seek, please contact me at my office at 727-822-3700 for a no-cost consultation.