Back and neck injuries are among the most common that clients come to us for in a personal injury law practice. Some are transient soft tissue whiplash injuries which can range from minor and temporary to those that can be painful for life to spine fractures and spinal cord injuries that cause permanent disability.
A stack of bones called vertebra form the spinal column. Natural shock absorbers called intervertebral discs form cushions between the vertebra. Discs have a tough outer layer surrounding a squishy inner core. In taking depositions of doctors for use at trial, we often compare discs to a “jelly donut.”
The spinal cord a bundle of nerve tissues running through the center of the spinal column. The spinal cord carries communication between the brain and the rest of the body. Through openings in the spinal column major nerve branches communicate to the arms, legs, and various parts of the torso. Paraspinal muscles surround the spinal column.
Almost as soon as one reaches adulthood, subtle degenerative changes may begin. As we age, natural changes to the spine are universal. Discs begin to weaken and dry out, losing some volume. Vertebra develop arthritic changes.
In virtually case of back injury to a person over 30 or so, we treat it as a matter of traumatic aggravation of a preexisting condition of the back. By 40, most people have some degenerative changes visible on x-rays or MRI. By 50 or 60, a radiology image of a spine may look like “forty miles of bad road,” even though there is no pain or problem affecting one’s life. Then a trauma causes the previously painless natural condition of the aging spine that not caused any problems to become painfully disabling.
In a trauma, such as a motor vehicle collision, the spine may be whipped around in a manner that causes an injury.
- The most common back injury is damage to the muscles surrounding the spine. Microscopic tears to muscle tissue lead to bleeding and formation of permanent scar tissue. While many people recover within a few weeks, the tissue may be more vulnerable to future problems.
- Trauma may cause weakening of the outer layer of discs is the area of the back placed under greatest stress. The “jelly” in the “donut” begins to bulge out, pinching a nerve and causing pain, numbness or tingling. Such a disc bulge may progress to a herniation in which virtually all the jelly is out of the donut. Depending on where it is located, it may cause motor weakness in an arm or leg, incontinence, etc. This typically requires surgery. The traditional surgery for a herniated disc involves removing the disc and fusing the adjacent vertebra with bone tissue.
- Fractures of vertebra also very often require surgery to stabilize the spine with metal plates and screws. Sometimes, particularly with older patients with osteoporosis who may not be good surgical candidates, physician choose to inject a bone cement in a procedure called verebroplasty. Some more subtle fractures can be managed conservatively with braces and therapy without surgery.
- The most devastating back injuries involve damage to the spinal cord, which can produce paralysis, either quadriplegia (loss of use of both arms and legs) or paraplegia (loss of use of legs).
We have experience representing clients with all degrees of back injury. In doing so, we have worked with all medical and rehabilitation specialties, and with a variety of medical illustrators who help us explain the injury graphically to a jury.