Did the Accident Cause the Disk Herniation?

Did the Accident Cause the Disk Herniation?

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Hi I'm Dr. John Shim, and today I will try to answer a very common question. Did the car accident cause my disc herniation? To really know the answer, we must have an MRI or study of the spine immediately before the accident then immediately after the accident another MRI or study. if there's a new disc herniation identified, then the answer is yes. if not the answer is no. I suppose in the future as you get into your car maybe there will be a scanner to document your body before the car starts then you'll be able to have the answer right away well we do not live in the future we live now and without that immediate pre accident study the answer may not be that simple at about age 40 almost 50% of people will have some findings under spine MRI that at least one radiologist will call either a bulge herniation or protrusion not all radiologists will even agree on the readings the point is many of us already have disc herniations to our spine even before the accident well we might have spine pain after the accident and while we might get an MRI that shows a disc the disc herniations may not be the actual cause of back pain disc our nations can be the source of pain but we should be aware that there are many other potential sources of spine pain serious causes include tumors broken bones and infections arthritis conditions caused by aging and wear and tear can also be a common cause of spine pain there are also hundreds of muscles ligaments and tendons connecting the spine and any one of them can be stretched and cause pain factoring in the Communists of disk herniation and the many causes of spine pain there are still other aspects that need exploration before we can answer that important question for a disc to herniate there must be a force causing rupture of the outer layer or annulus auto manufacturers has spent millions of dollars to make cars safer one of the goals is to dampen two forces experienced by the occupants during the collision still from the perspective of a spinal specialist in general common sense does play into making judgments on two forces experienced during the collision the more damage the more likely the disc experienced a force that caused herniation should a disc herniation matically the resulting pain should be evident within a short period of time there are several reasons for this the nerve or spinal cord may be impacted by the disc herniation causing corresponding radiation complaints when the disc herniated also spills chemicals that will cause an inflammatory response to the surrounding tissues an accident induced traumatic disc herniation is a rapid event that's why another for a disc herniation to be considered caused by the accident you should have relative rapid development of pain with some corresponding nerve radiating symptoms folks with a prior history of chronic back pain should also experience a flare-up of the same also in almost any traumatic injury there will be some associated pain from the pulled muscles ligaments and tendons for these folks for the accident to cause a new disc herniation there should be a noticeable change of the pain pattern with additional nerve complaints there are many more nuanced aspects that need to be considered when answering the question as you can see the answer to the question did the accident caused my disc herniation is not so easy an answer I hope this did not cause more confusion this is dr. John shim and I want to thank you for taking the time to watch our video you you

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.

Citations

  • Sander AL, Laurer H, Lehnert T, El Saman A, Eichler K, Vogl TJ, Marzi I. A clinically useful classification of traumatic intervertebral disk lesions. AJR Am J Roentgenol. 2013 Mar;200(3):618-23. PubMed PMID: 23436852

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  1. I was rear-ended by another car 8 weeks ago no immediate pain at the time just pure shock, however, I am now experiencing chronic pain in my lower back
    I am seventy years of age and my vehicle being stationary at the time of impact bent the impact bar.

    1. You did not say when the present back pain started, whether you had it before, or what you have done. If there is no weakness, incontinence or numbness and tingling, you would probably benefit from some daily stretching exercises. Please see a physical therapist and learn how to do this most effectively. Always get these things checked by your MD if they don’t resolve. Good luck.

  2. I slipped on a grape or something small at a major grocery store at the very end of April 2018. Both of my feet went up in the air but my right ankle twisted somehow so when I landed on my left side (my toenail polish on my R big toe was “erased” from the landing). They have the footage and had their insurance company call me with a claim number. I was in pain for a couple days but didn’t go to the hospital as I felt if it got worse, I would. Ever since then, my back hasn’t been the same (lower R) but I just chalked it up as maybe I slept wrong. Well the other morning, I was getting up from my bed, which is a normal bed height, and I felt like a pop in my lower R back. Again, I chalked it up as nothing. Needless to say, that pain is getting worse. It’s to the point where I have to sit or stand crooked to make it kind of go away. I can feel it from the lower R down to the back of my thigh, sharp pain (like a straight metal rod that’s crooked), if that makes any sense.. I’ve been taking anti inflammatories and Tylenol, etc., but to no avail. I’m prescribed Valium, which can work as a muscle relaxant but again, nothing. It’s constant and I have NO record of back pain, at all. I’ve only had flank pain for UTIs and my urologist said my kidney is fine. So, my question is: Is it possible after two months for an injury to come to light, per se.? Please advise, thank you.

    1. I think the “pop” in your back is probably the culprit. We have seen people herniate a disc with a sneeze. Please see a medical professional if this not resolve. Often, all you need is some physical therapy.

  3. Dr. Shim, I had my lumbar spine fused in Oct 2017. In January of this year I complained of dramatic increase in pain due to PT. I was told by surgeon to stop PT and return if issue continued. I returned in March with more pain. Sent for x-rays and the report was faxed. I was given a BLANK disk from the radiologist. The PA never mentioned the blank disk. She stated significant damage above and below fusion, hardware intact moderate to severe retrolisthesis . I was never informed of this at a different doctor, who stated report doesn’t say anything and the disk is blank. I learned my spine was fused uneven when getting recent x-rays. I have lost dramatic weight,severe pain, hip pain to right knee, trouble breathing etc. My surgeon has denied responsibility. I do not care what happened in past, I want relief from pain. How would you proceed?

    1. Jim,

      Please do not take any information as a specific comment to you or your situation. As you already know, I cannot give any patient specific recommendations online. The terms you have used to describe the disk is not ones used standardly by physicians, so I am concerned there is some interpretation issues that need explanation from a spine specialist. For anyone with continued pain after a procedure, a thorough evaluation by a spine specialist is the best way to understand your situation. Recommendations can only be made after obtaining that evaluation. When calling an office to obtain the evaluation, make sure the scheduling staff knows about your prior surgery. Some spine specialists will not be willing to evaluate you until they have had the chance to look at some of the prior records.

  4. Thanks for this great article. I was in a car accident and had no (zero) pain afterwards. The wreck was substantial and about 11 weeks later a disc in my lower back herniated. My h8sband has been upset thinking the wreck caused my back problem. The wreck was his fault, he fell asleep driving. But I had NO pain after the wreck, at all. This article helps so much, in being able to reassure him that the accident did not injure my back.

    1. So nice to hear from you Wendy and to know that one of our blogs set your mind at rest. I hope you are doing well and will continue to check out the website.

  5. Great insight, Dr. Shim. I had an accident involving my Neck but did not feel Neck pain until 11 weeks after the accident. I eventually had a cervical MRI and found disc herniations in my neck. I did have severe dizziness immediately after the accident and went to the ER. Is the dizziness suggestive of trauma causing disc herniation? I did not have Neck pain or radiculopathy until about two and half months later.

    1. Hi Jarrett, The timing of the onset of symptoms makes it unlikely that the accident is the cause of your herniated discs. However, I don’t know your history, so this is something you need to discuss with your own physician. Good luck.

  6. I have a question; I was in a high speed rear ending, last July. It totaled my car, and gave me great problems in this year. I was in pain, and trauma right after making my insurance claim, and drove my self to emergency. They did their trauma evaluation, and said I was fine. But my back was hurting, and they told me it was just shock, and I was other wise fine. I tried to shake off the pain, and tried to do my new job. I ended up in extreme pain, and wasn’t able to work anymore/ lost my job. Meanwhile, I saw my chiropractor, who set up an MRI for me, the MRI said I have 3 herniated discs. He started physical therapy, but it wasn’t working for me. My toes were cramping, I was weak in my forearms, hard to bend over, major pain across my belt line, and just below my shoulder blades. and ” Sock Effect.” across my feet, legs and arms. I saw a specialist, who forwarded me to a PT center, with a script, and set me up for spine injections. They were helping. Until Allstate, my insurance cut me off, after seeing their doctor for the IME, saying it was all in my head. I am a Psychologist, its not in my head. This is the first time I have dealt with this. Now, out of work, I cant afford the PT, 250 a visit. Or the Spine Injections, at 1,500 a shot. I was pretty active before this. In fact the week before the accident, I was helping fix my parents roof.. WITH NO PAIN, and taking bundles of shingles up on my shoulder, and lifting roofing sheets- with no pain in my back at all. I am going to court soon in the lawsuit I filed. What would be a way, the “other side” could argue, that the accident didn’t cause my back problems. Thank you for your thoughts on this.

    1. Hi Adam, sorry for the delay but I am forwarding this one to Dr. Shim. Will get back to you on or before Monday with your answer.

    2. Hi again Adam. I spoke with Dr. Shim about your questions. His biggest advice was to tell your attorney everything in your history, as surprises are never welcome in a trial. The insurance company generally looks for pre-existing problems, old MRI’s proving there were problems before the accident and proof that the claimant is able to do things they say they are unable to do. Be well!

  7. I thank you for your explanation on this website. However, I will add that when medical professionals such as yourself, and as do radiologists and doctors in general, make statements such as ‘may have occurred…’ or ‘ these pre-existing conditions…’, damage is done legally by the unprovable, and indeterminate words used that add fuel to the fire of insurance provider’s efforts towards deniability of responsibility. Unless you have recently done an MRI or a complete examination before the alleged accident occurred, then factually, you have no rational reason to state that this arthritis, or any other conditions were pre-existing. That is a presumption that can be very harmful to the injured person who is seeking medical treatment. There is a preponderance of research evidence that shows the development of post traumatic arthritis and other conditions that are usually, and carelessly described as degenerative, pre-existing and/or chronic in nature are in fact caused by the trauma itself. That includes all types of trauma to muscle, bones, joints, and so on. The ‘degenerative’ changes actually begin to occur almost immediately after the trauma. In days changes in the tissue can be determine, Within a few weeks, the full blown ‘degenerative’ conditions have manifested.

    1. Intersting comment. As an orthopedic surgeon, i am asked to give my opinion on this topic. If you carefully read my blog, I will always consider the situations and fqctors leading up to the decision to get testing. The testing in isolation, can not be the only determining factor on coming to the conclusion of a very complex situation. In the perfect scenario, there will be a test seconds before the accident, immediately after the accident, then a few days afterwards. That perfect scenario can only be obtained in the lab. In real life, it comes down to a combination of history, physical examination and testing. Thanks again for your comment.

  8. I check out blog sites like this a lot. As a long time sufferer of chronic back
    pain from a car collission I have a lot of free time.
    LOL. However, I’ve never ever been compelled to publish a comment,
    till now. Fantastic post. I enjoyed reading it. I have actually bookmarked your site and shared this post
    on my Facebook wall.

    Thanks once again for your quality work!

  9. Candid Frank and Honest Commentay and analysis . Very Credible . The only way I’d take an apparent no visble damage car accident claim is if the mechanic looked under the bumper and found a damaged “bumper guard’ Thse are made of steel and can become depressed and deformed . The bumper itself may be plastic like and bend and pop back to normal so outwardly there looks to be no damage but underneath there is concealed damage indicating a forveful collision..

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