Back injuries — specifically, lumbar and cervical disc injuries — are some of the most common injuries caused by trauma in motor vehicle crashes, falls, and other accidents. In our cases, we are routinely faced with defense lawyers and insurers who try to argue that these injuries to our clients are “degenerative,” and therefore unrelated to the trauma underlying our claim, as a basis for offering less than fair value to resolve our claim.
Successfully representing clients with disc injuries to their back requires — at a minimum — a thorough understanding of the medical terminology used in lumbar, thoracic, and cervical imaging and radiology (X-Ray, CT, MRI) — and a recognition that such imaging usually cannot rule out trauma as a cause of the abnormal findings (pathology) seen on imaging. Oftentimes for us as personal injury lawyers, developing the clinical findings both before and after the trauma — namely, the client’s symptoms, level of pain, limitations, activities, etc. — allow us to prove that the particular trauma involved was “a cause” of the injury — even in the face of imaging describing the abnormal disc as “degenerative.”
Seminal Article on Lumbar Disc Terminology
In too many courtrooms and in too many depositions, lawyers representing injured plaintiffs are unprepared to respond to the argument from defense lawyers and their paid doctors that based on the imaging they reviewed of the injured plaintiff, the particular disc injury was a degenerative condition that pre-dated the traumatic incident at issue, such as a car accident.
A review of the seminal article on lumbar disc pathology, “Lumbar disc nomenclature: version 2.0,” published in 2014 by the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, provides personal injury lawyers and their clients with the tools to innoculate such a defense.
The article provides standard definitions for normal and pathologic conditions of the spinal discs — as seen on imaging (radiology) studies — focusing on the lumbar spine, but also noting that the principles discussed may equally apply to the thoracic (or dorsal) and cervical spine as well.
One of the biggest takeaways from this article is the following paragraph, which makes clear that the radiologic findings classified as “degeneration” cannot be used to rule out trauma as a cause of the disc injury and associated symptoms, but rather is a matter of clinical judgment:
Whether or not a “less than violent” injury has contributed to or been superimposed on a degenerative change is a clinical judgment that cannot be made based on images alone; therefore, from the standpoint of description of images, such discs, in the absence of significant imaging evidence of associated violent injury, should be classified as degeneration rather than trauma.
For example, we represented a man who began developing significant low back pain radiating into his legs following a low speed, rear-end car accident. An MRI of his low back revealed degenerative findings (disc space narrowing, osteophytes, diffuse bulging of the annulus, inflammatory changes). The defense hired a doctor to opine that, based on the degenerative findings on MRI, his injury was pre-existing and was not caused by the car accident. We were able to use the recognized medical literature to show that the MRI findings said nothing about the cause (or “etiology”) of the pathology, symptoms, or need for specific treatment. Rather, those are clinical judgments guided by the patient’s symptoms (and findings, if any) before vs. after the trauma.
Other Important Spinal Disc Definitions and Discussion
- The term “Normal” should be used to describe lumbar discs “free of any changes of disease, trauma, or aging.” The majority of people over the age of 40 will have radiologic signs of aging (degeneration) — therefore, even some clinically “normal” (asymptomatic) people will have abnormal radiologic findings.
- The term “annular fissure” is preferred to “annular tear” because the term “tear” could be misconstrued to imply traumatic etiology.
- Herniated discs — defined as displacement of disc material (nucleus, cartilage, fragmented apophyseal bone, or fragmented annular tissue) beyond the intervertebral disc space — may be classified as a “protrusion” or “extrusion”; a disc “bulge” is not considered a form of herniation, although it is sometimes used by doctors to describe a herniation
- “The term ‘herniated disc’ does not imply any knowledge of etiology, relation to symptoms, prognosis, or need for treatment”
- The term “trauma” includes disruption of the disc associated with evidence of “violent fracture and/or dislocation,” however it does NOT encompass “less than violent trauma to the degenerative process, fragmentation of the ring apophysis in conjunction with disc herniation, or disc abnormalities in association with degenerative subluxations.”
People who suffer from pain, numbness, weakness or other symptoms relating to a spinal disc injury following some type of traumatic event, such as a car accident, often face an uphill battle to convince negligent defendants, their insurance companies, and ultimately a jury, that the traumatic event was “a cause” of their injuries. Our attorneys have the experience, expertise, and compassion to ensure our clients in such cases receive the full measure of justice they deserve.
For a free consultation to discuss a potential case with one of our attorneys, call us at 312-527-4500.