Your client has had an exacerbation of their chronic back pain after a recent motor vehicle collision (MVC). The MRI showed a few herniated lumbar intervertebral discs. Is it possible to determine whether the herniated discs were due to pre-existing disc degeneration versus traumatic injury? Let’s dig into the research to find our answer.
What does the research say?
Often, herniated discs do not cause symptoms. Research has shown that spine degeneration on imaging is present in high proportions of asymptomatic individuals, increasing with age. Brinjikji et al. found that disc protrusion prevalence increased from 29% in 20-year-olds to 43% in 80-year-olds.1 Because of their high prevalence in the population, a client’s presentation with disc herniation, even with a history of recent MVC and complaint of recent-onset pain, is insufficient to justify the assignment of causation to the motor vehicle collision.
One interesting fact is the amount of force that is required to produce a traumatic disc herniation. Researchers from the Center for Applied Biomechanics, Mechanical and Aerospace Engineering reviewed biomechanical literature evaluating the spine under a wide range of loading conditions to determine how much force is required to cause injury. Their literature review found that when a large load is applied to the spine, the intervertebral disc is consistently “stronger than the adjacent bony structures in virtually all loading modes and, therefore, vertebral fractures or ligamentous injuries occur before an isolated disc extrusion.”2
Along with these biomedical researchers, the clinicians who contributed to the AMA Guides to the Evaluation of Disease and Injury Causation found that there was no evidence that minor trauma causes lumbar disc herniation.3
Q: What if we can compare imaging done before and after the accident?
The North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology released consensus recommendations that speak to this. They opine that disc herniation in the absence of significant concomitant trauma “should be classified as degeneration rather than trauma. If there is significant trauma associated with the herniated disc, then yes, the herniated disc can be attributed to the MVC.4
Ultimately, an opinion on causation when a MVC occupant presents with a disc injury must be done with careful analysis, based on the specifics of that presentation and the crash circumstances.
The Takeaway
As medical professionals, we work hard to help our patient-clients to regain quality of life after traumatic experiences. We will continue to do right by them and use the research to improve their health outcomes. For each case, we will strive to minimize unintended harm while maximizing settlement outcomes.
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- Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173 ↩︎
- K Kent, R., Cormier, J., McMurry, T. L., Johan Ivarsson, B., Funk, J., Hartka, T., & Sochor, M. (2023). Spinal injury rates and specific causation in motor vehicle collisions. Accident; analysis and prevention, 186, 107047. https://doi-org.kumc.idm.oclc.org/10.1016/j.aap.2023.107047 ↩︎
- Eskay-Auerbach, M. (2005). Medical-legal Aspects of the Spine. Lawyers & Judges Publishing Company. ↩︎
- Fardon, D. F., Williams, A. L., Dohring, E. J., Murtagh, F. R., Gabriel Rothman, S. L., & Sze, G. K. (2014). Lumbar disc nomenclature: version 2.0. The Spine Journal, 14(11), 2525–2545. https://doi.org/10.1016/j.spinee.2014.04.022 ↩︎