Back injuries are the most common injuries seen in motor vehicle accident cases. Frankly, back injuries are also the most common target for those who pretend to be injured and present fraudulent claims. This unfortunate reality makes it far more difficult for the true victim of a back injury to be fairly heard.
Back pain is a common and major health problem that extracts an enormous emotional and financial toll on the patient. Eighty percent of the population experiences back pain during their lifetime, and back pain is the second leading cause of missed time from work in the United States. While back pain can occur without trauma, traumatic injury to the spine can cause very severe and debilitating pain with symptoms radiating into all extremities.
The spine is actually a series of joints. The vertebrae are the small bones that align one on top of the other and extend from the base of the skull to the bottom of the pelvis. There are seven bones in the cervical spine, typically labeled C1 through C7. There are twelve bones in the thoracic spine, labeled T1 through T12. There are five bones in the lumbar spine, labeled L1 through L5. There are five fused bones that make up the sacrum, labeled S1 through S5. The coccyx or tailbone is a structure composed of four fused bones located at the very base of the spine.
In between each two adjacent vertebrae, a soft-tissue pad exists to separate the vertebrae, to cushion the joint, and to facilitate joint motion. Injury to this pad is commonly called a “disc injury.” The medical term for this pad or disc is a nucleus pulposa.
Trauma to the spine can result in damage to the spinal ligaments, connective tissues, surrounding muscle structure, or the bones or discs. Disc damage can range in symptomology from mild to severe and from temporary to permanent. Because the nerves of the spine pass through openings in the vertebrae along the range of the patient’s back, damage to the vertebrae or discs can cause stenosis, which is a narrowing or squeezing of the joint space where the nerves reside.
In some spinal injury cases, symptoms are not immediately perceived by the victim. This is because nerve involvement is often progressive and can occur and increase over time. These injuries are often latent, meaning they are symptomatically dormant for some period of time. Thus, you may be dealing with a very serious spinal injury that has not yet presented pain or other symptoms. If your collision involves significant force and/or speed, it is wise to be carefully diagnosed and evaluated for spinal injuries.
Damage to the intervertebral disc / nucleus pulposa is typically of three varieties and can also occur as a combination of all three types:
- Bulging Disc — A bulging or slipped disc occurs when the nucleus pulposa is pushed out of the normal location such that it extrudes beyond the perimeter of the adjacent vertebral surface. If the bulging disc extrudes rearward into the nerve passage, this can impinge the nerve, causing significant pain and limitation.
- Ruptured or Herniated Disc — The nucleus pulposa consists of a multilayered outer skin, called the annulus, and protein pulp contained within the annulus. If the annulus is torn, allowing the disc contents to escape, this is called a ruptured disc, herniated disc, or herniated nucleus pulposa. This condition often requires surgery to replace the disc with a prosthetic pad or to remove the disc and fuse the surrounding vertebrae. This is a very serious condition requiring careful medical and legal consideration of all past and future treatment costs and physical consequences.
- Torn Annulus — If the skin of the disc is partially torn but the protein pulp is not freed from the annulus, this injury is called a torn annulus. These injuries can be difficult to diagnose but are the common source of very severe back pain arising from trauma.
Fractures to the vertebrae are also common in collision cases. The medical response and the severity of the injury typically depend on the location of the fracture, the extent that the fracture affects the anatomy and function of the bone, and the number of vertebrae involved. Orthopedic surgeons and neurologists are often involved in the care and treatment of these injuries.
Whiplash injuries typically refer to injuries that do not involve vertebral fracture. In most of these cases, the primary damage is to the muscles, ligaments, and connective tissue around the spine. These injuries are complex and difficult to treat. For some patients, the effects of whiplash can last a lifetime. Chiropractors, orthopedic doctors, and physical therapists are most commonly involved in the treatment of these injuries.
In all back injury cases, insurance companies always look at the patient’s history of prior complaints. They also will commonly place unfair weight on any degenerative findings in X-rays, MRI and CT imaging, and in other medical notes and diagnostic reports. Do not allow your adjuster to deny your back injury claims on grounds that there is evidence of degeneration. Every individual aged thirty or older is properly classified and diagnosed as having “degenerative disc disease.” Simply put, all of us experience degeneration in the spine at and after age thirty. Patients with severe degeneration, such as cases involving osteophytes (bone spurs), severe arthritis, spondylosis (disease process of the bone that occurs over time), scoliosis (improper curvature of the spine), and other similar conditions would have more difficulty proving that their back injury was caused by the collision. However, even if you had back pain and problems before an accident, the responsible parties certainly owe for any worsening of your condition. Careful legal steps must be taken to organize and present all medical evidence to properly prove the impact of the collision on spinal health.