Did the Accident Cause the Disk Herniation?
That is a frequent question asked by many patients.The answer is, a definite maybe the accident caused the disk herniation.
As a practicing orthopaedic spine surgeon, I have seen many patients with complaints of pain after an auto accident. In my community, I have also been asked to evaluate patients in Auto accidents by attorney representatives of insurance companies. The question is, Did the Accident Cause the Disk Herniation? If so, are the treatments appropriate? A corollary, which is also common, is did my work injury cause the disk herniation?
Everyone involved in the situation would like a definitive answer to that question. Unfortunately, often times the answer is not so simple. To answer, I usually need to ask other questions of the patient, and confirm that the medical records support that answer.
How old is the patient? After the age of 40, there is a 50/50 chance that the patient already has a disk herniation. The disk herniation may have occurred long ago, and may have been completely pain free for a long time. MRI’s will demonstrate the disk herniation but it is rare that signs of acute disk herniation will be present. Those signs such as edema around the disk herniation, or hemorrhage by the nearby tissue require such a force, that usually, there are also other associated injuries or complaints. With those findings, it is easier to say the disk herniation is new and associated with the recent injury. Unfortunately, Most MRI’s will not show those findings, therefore, at a certain age, the disk findings by themselves are common, and therefore not conclusive of a newly formed disk herniation.
What findings are on the MRI? Can the findings determine Did the Accident Cause the Disk Herniation? Regarding disk findings on MRI, disk bulges secondary to disk dehydration is usually not an acute finding. Neither is evidence of osteophytes, which are bone spurs associated with degeneration. At one time, physicians put alot of weight on the so call High Intensity Zone, which usually indicated the presence of a tear in the outer part of the disk, which is called the annulus. Now we know that these High Intensity Zone lesions can be present for years, and therefore do not necessarily mean a new disk injury or herniation. As stated above, findings of edema and hemorrhage are rare, but if found, do indicate an acute event. If not found, you still cannot say the disk herniation is not acute, but you cannot say by image it is acute either.
When did the pain start? Can the timing determine Did the Accident Cause the Disk Herniation? I find this to be a very important question. After the accident, in my opinion, a person that had an immediate, or within a few hours development of neck or back pain, with developing arm or leg pain is more likely to have a disk herniation associated with the accident. There are disk herniations associated with just back and neck pain only, but usually, for a disk herniation to become symptomatic, there is an association with nerve irritation, or as we physicians call it, radiculopathy. Once in a while, I will see a person involved in an accident, but with no real complaints of back or neck pain. After some time, usually greater than a few weeks, they may develop some neck or back pain. For what ever reason, they get a MRI, and since they may be in the over 40 population, the MRI does demonstrate a disk herniation. While this person is convinced the disk herniation was caused by the accident, in my opinion, it is difficult to relate the disk herniation finding to the accident after such a time delay. In addition, the person usually does not have the corresponding radiculopathy findings consistent with that particular disk herniation. The timing is very important. There is no dispute that there is a disk herniation. The question however, is not that there is a disk herniation, but did the Accident Cause the Disk Herniation?
Has the person ever had similar complaints in the past? Can prior complaints determine if the Accident Caused the Disk Herniation? The answer is maybe. Back and neck pain is a part of life. Most people have had a pulled neck or back muscle with activities of life. That is why there are so many terms for a back ache. Lumbago, sciatica, pulled back, wry neck, crick in the neck, kink in the back, etc. Minor neck pains and back pains are common and expected. In my opinion, there is a difference between a minor neck or back ache experienced rarely, and a constant chronic neck or back condition that required constant treatments by a physician, chiropractor or therapist. If you have an accident, but have recurrence of the similar prior chronic condition, it is likely that the accident flared up a pre-existing problem. But, if the accident caused a new set of complaints shortly after the accident, and even though you may have had a pre-existing condition, there is a definite change of complaints, the accident may cause a new change to the disk, the accident may have caused the new disk herniation.
Can a prior identified disk herniation become symptomatic after an accident? In my opinion, there is that possibility. I have seen circumstances by which a person has had a test long ago demonstrating a disk herniation. Then for a long period, there is no pain associated with that disk herniation. But, after an accident, there is a quick development of significant pain with corresponding radiculopathy. The pain does not improve or go away. In that scenario, Did the Accident Cause the Disk Herniation? The answer would be no. But, the accident did cause a permanent aggravation of a pre-existing condition. So in that circumstance, the accident did cause a pre-existing condition to become a permanent injury.
Can the Energy of the accident determine if the Accident Caused the Disk Herniation? I am not a biomechanics expert, so I am told that a low energy fender bender will not likely cause a disk herniation. While I think that is the general case, in the end, it comes down to history of the development of the pain and the nature of the pain. Some patients are very frail, and some are predisposed to getting injured with minor forces. In some instances, It is my opinion that a low damage, low energy impact can still cause disk problems. It comes down to the history and clinical presentation.
In the end, as a practicing orthopaedic surgeon, after reviewing all the history, and all the records, and after looking at the MRI’s and other images, my conclusions are based on the entirety of the information. And I can say I have been wrong when trying to answer Did the Accident Cause the Disk Herniation? It does come down to the credibility of the history when the records do not match. I know there are some people who just cannot explain their pains properly, or did not go to the hospital immediately after the accident because they hoped the pain would go away, or was afraid of the costs. Unfortunately, their recollections may not match the evidence, and because of that, the history is wrongly discounted. I can say I may have been wrong with my conclusions in that scenario. In another scenario, I believed the history, and the records were also consistent with an accident related disk herniation. But, to my chagrin, that person also had surveillance video’s showing the person performing exceptional physical feats immediately after the accident, or after my evaluation. My opinion about the significance of the disk herniation was likely wrong.
The bottom line is the answer to that question is not always straightforward. Did the Accident Cause the Disk Herniation? It depends on the factors discussed above. It also depends on the credibility of the historian, and the otherside would argue, the bias of the person answering the question.
Last modified: March 18, 2019