Car accident spinal cord injuries | Palm Beach County Car Accident Lawyer

Spine Injuries Causing Pain and Suffering to Car Accident Victims, a Lecture By Dr. Craig H. Lichtblau, M.D., P.A.

Because cervical and lumbar spine injuries to Palm Beach County car accident victims are such a large part of most personal injury practices in West Plam Beach, un­derstanding the anatomy, biomechanics, and pathology of the spine can be very helpful to most Florida, or West Palm Beach personal injury attorneys. In medical school, weeks if not months are dedicated to learning and understanding the intricacies of the spine. Most of the significant injuries to the spine deal with impingement of the spinal cord or nerve roots as they travel down or exit the spine.

These neural elements travel down the spine through the spinal canal. The spinal cord typically extends down to the approximate level of L1. Nerve roots exit the spinal canal through gaps between each

vertebrae called "neural" or "intervertebral foramina." Typically, injury to the spine results in restrictions of one of these canals resulting in pressure on the spinal cord or nerve roots that in turn, causes weakness and/or pain. The resulting pain may be localized to the area of the spine that was injured (i.e. restricted to the neck or back), or the pain and weakness may be in a "radicular" or dermatome pattern (a pattern consistent with the muscles and skin that are supplied by a specific nerve root).

They will typically argue that "bulges" are much less signifi­cant injuries than "herniations." In truth, no matter what label is placed on the disc pathology, the resulting compromise of a neural canal and impingement on the neural element is just as real.

Most often compromise of the canals is caused by disc bulges or herniations. These disc injuries are described and classified in many ways, with counsel for insurance companies placing a great deal of emphasis on the descriptions of these injuries.

Often a patient may suffer local spine pain and even radicular pain without evidence of neural element compression. In these situations, defense counsel and even treating physicians may fail to appreciate mechanisms of nerve root irritation, which can cause symptoms that are just as severe as compression of the nerve root by a bulging or herniated discs. These mechanisms are well documented in medical literature and are referred to as "Discogenic Pain." This pain can be the result of two different etiologies. These etiologies are the percep­tion of pain either 1) by small sensory nerves to the injured disc itself or 2) irritation of the nerve root by chemicals released by the injured nerve root.

Osteophytes are another primary cause of neural compromise. Osteo­phytes can form at margins of joints (such as intervertebral or facet joints) as a result of trauma. During impact, injury to the bone (or to the liga­ments closely adhered to the bone) can lead to overgrowth (hypertrophy) of the bone as it attempts to heal. Formation of osteophytes typically takes several weeks to occur after an injury. For that reason, osteophytes found evident in imaging studies taken immediately after a traumatic event, were not likely the result of that event. However, the presence of preexisting osteophytes does make an individual more susceptible to traumatic injury. The spinal cord or nerve roots traveling through neural canals (spinal canal or neural formina) that may have been somewhat restricted by these pre­existing, asymptomatic osteophytes are much more vulnerable to trauma.

It is also important to note that even though osteophytes may have been present prior to a traumatic event, typically the client's injury is the result of a disc/osteophyte complex. In the majority of cases, it is not the osteophytes that are causing the most significant neural compromise and compression. Instead, the disc material typically extends beyond the osteophytes to compress the spinal cord or nerve roots. In situations where a plaintiff was asymptomatic prior to a traumatic event, arguments should focus on a truthful and likely series of events. These events have stemmed from the fact that abnormalities of the intervertebral joint and disc made this area particularly susceptible to trauma. During the traumatic event, the disc between the preexisting osteophyes are further injured, exacerbating the disc protrusion, neural compromise and compression.

Joint injuries and long term post-traumatic joint pain that may necessitate surgical intervention are typical results of trauma. Each typical intervertebral articulation consists of three joints --an intervertebral joint and two facet joints. Injuries to the ligaments of these joints can result in instability of the joint.lnsta­bility can result in one vertebra sliding over another such to a degree that may compromise the neural canals and/or case nerve root compression. This instability is sometimes noted in imaging studies and described as anterior or posterior "Iisthesis" of one vertebra over another. As many imaging studies are typically taken with the patient in a relaxed position, this instability may not be evident. Therefore, flexion and extension films may be more helpful in diagnosing this condition.

Direct injury to the facet joints or ligamentous intability can also lead to a facet arthropathy. This is a painful condition that results from the deterioration of the facet joint as a result of excessive wear and tear. This pain is typically localized to the spine; however, as the condition advances, hypertrophy of the facet joints can result in compromise of the neural foramina and nerve root compression that can lead to radicular pain as well.