Tissue Spinal Injuries Caused by Accidental Injury
One of the historic problems in recovering for soft tissue back and neck injuries has been demonstrating the injury to juries.
All juries have heard of the proverbial “sore neck” and the exaggerating or faking plaintiff. Only the patient can feel her neck, but how can juries know an injury exists? In the past, plaintiffs have presented the testimony of their treating doctors to describe how these injuries can occur and exist in a given case.
The defense in these cases hires doctors to testify against the plaintiff at trial, usually after a cursory, one-time examination of the injured plaintiff. These “company” doctors are not hired to help cure the plaintiff, but to appear at trial and testify against the plaintiff. Historically the decisions in these cases have come down to whether the jury believes the plaintiff’s doctors, who were retained to treat the plaintiff and make the plaintiff well, or the defense doctors, who are hired guns, hired only for the purpose of litigation.
With respect to spinal injuries, there are three primary ways that are now developing to demonstrate the presence of the injury to the jury. They all involve imagining. Two involve X-ray and one a type of MRI.
In the first instance, a conventional X-ray is taken of the injured neck, for instance. Typically, if a person hurts their neck in an automobile collision and goes to the emergency room of the average hospital, X-rays are taken of the neck. With respect to identifying such injuries, the X-rays taken at an emergency room are worthless.
The emergency room is looking for injuries that require immediate care. Often, many even serious neck injuries do not require emergency care.
Therefore, the X-rays are taken in what is called a neutral position. An example would be an X-ray of a person lying down, on a table, with a support mechanism under their neck. If the ER X-ray discloses a fractured vertebra, it only sometimes requires immediate emergency medical treatment.
However, absent that, ER radiologist will characterize the X-rays of a non-fractured neck as normal even though there may be undisclosed injuries – ER X-rays are not calculated to disclose injuries that are not of a life-threatening variety.
However, normal X-rays of the neck often fail to disclose serious injury. Ligaments and other supporting soft tissues give the neck structure and keep the bones and joints of the neck in proper alignment so that nerve roots coming out from the spinal cord to carry information back and forth from the outlying portions of the body are not pinched at their source in the spine.
When ligaments are stretched or torn, they are not like a rubber band. They do not return to their original position and function of giving flexibility and stability to the spine.
Extraordinarily stretched or torn ligaments create instability in the spine that allow bones to move out of place and pinch nerves that are essential to the normal functioning of the body.
The presence of these problems is frequently not evident in so-called normal X-rays taken in a neutral position. However, if the X-rays are taken while the patient is upright, either sitting or standing, and taken while the patient leans forward and touches his chin to his chest, or reaches his head way back, these unsupported vertebrae move out of position, sometimes dramatically.
The American Medical Association has adopted standards for measuring this type of movement, and rating disability by the extent of the movement. Movements that are classified as disabling rarely appear in X-ray taken in a neutral position.
It is necessary to take what are called flexion-extension X-rays to see and measure the extent to which the movement of these unstable spinal segments exceed AMA guidelines and are rated as permanently disabling. These types of X-rays are not taken in emergency rooms. They are frequently not taken by treating doctors.
Once full flexion and extension series X-rays are taken, the degree of movement at the extremes of flexion and extension can be measured and compared to standards, such as the AMA Guidelines.
Other standards for measurement are the Croft Cervical Injury Guidelines, which are used by Dr. Jeffrey A. Cronk, Director of Education at Spinal Kinetics (715-833-8533). Dr. Cronk, and Dr. Arthur C. Croft, are chiropractors with national reputations.
At Spinal Kinetics, conventional X-rays are received from treating doctors to be digitalized by computer, which allows precise measurements of the degree of variation from the accepted standards for the movement of vertebrae in accordance with accepted protocols for making such measurements. In that way, the extent of ratable disability can be accurately measured and determined.
A more elaborate form of X-ray that is calculated to disclose permanent spinal instability is called video fluoroscopy. The most advanced form of this is called DMX. In this form of X-ray, an X-ray video is taken of the neck as it flexes and extends to its maximum limits; these X-rays show a video of the bones of the neck as they actually move. When this is done, aberrational movement is disclosed as the X-ray shows the neck in movement.
Movement that exceeds AMA Guidelines is sometimes only seen in this type of imaging as it shows the neck in each position through which it moves, which may disclose movement that is not revealed in conventional static X-rays that show the extremes of flexion and extension.
Finally, X-rays fundamentally show only bones. There are other soft tissues, such as intervertebral disc’s, that are made to swell, bulge or rupture by injury, which can cause the pinching of nerves just like misaligned vertebrae bones do. Usually the best way to view these tissues and the effect that they have when injured is by Magnetic Resonance Imaging, or MRI. Again, MRI’s are not very helpful if taken in a neutral position while the patient is lying prone.
MRI best discloses these injuries if taken when the patient is standing or sitting, in positions of flexion and extension. An even more sophisticated technique is what is called a motion study, in which individual static MRI are looped together to show by video what the cervical spine would look like in motion. It is this motion that discloses permanent abnormalities caused by trauma that are not otherwise visible in any kind of X-ray.
So what do all these modalities accomplish? What they allow attorneys representing injured persons to do is to actually show juries pictures of the injuries and the abnormal movement of spinal bones as measured against recognized standards for measuring disability.
MRI’s permit the demonstration of the same dynamic caused by nonboney tissues such as intervertebral discs. These modalities objectify the evidence of injury and take the establishment of the injury out of the sole realm of conflicting medical opinion.
If you have a serious back or neck injury and it is not being subjected to this kind of analysis, the existence of your injury is not being objectively proved. Your case will not be sufficiently persuasive.
Additional reading: Chiropractic physical therapy, claim adjusters, negligence, personal injury, insurance companies and claims.
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