Spinal Injuries - Neck & Back Injuries

DIAGNOSTIC STUDIES ARE OBJECTIVE AND PROVIDE FORENSIC EVIDENCE THAT CAN BE EFFECTIVELY USED BY EXPERIENCED ATTORNEYS:  When you have been injured in an auto accident or fall, some sophisticated diagnostic studies can be critical in objectively verifying your injuries. Diagnostic studies can be essential in a case where there are persistent complaints of pain or symptoms after 4-6 weeks, and the insurance carriers are skeptical. They will employ their established tactics and well-paid defense experts to undermine your medical condition if diagnostic studies are not obtained in a timely fashion. Here are some of the basic diagnostic studies that are valuable in any given personal injury case. This website is intended as a general overview and is not intended to provide medical advice. All diagnostic studies should be ordered by your doctor to comport with your individual medical needs, symptoms, and injuries. Child & Jackson attorneys have litigated thousands of spine injury cases, having deposed and cross-examined hundreds of spine experts (neurosurgeons, orthopedic surgeons, orthopedists, radiologists, chiropractors, etc.). This experience matters, as the insurance carriers will hire these same types of experts to minimize or rationalize away the causation of your spine injuries, and you need an experienced attorney in spinal injuries to impeach these experts with objective diagnostic studies and admissible medical evidence and research.   

MRIs [Magnetic Resonance Imaging Studies]: MRI machines use strong magnetic fields, radio waves, and field gradients to generate images of your body. There are two basic types of MRI machines: Open and Closed. They both have advantages and disadvantages.

CLOSED MRIs: Closed MRI machines tend to be shaped like a donut. See IMAGE. Patients are placed in the Closed MRI machine while the imaging study is conducted. This can usually take 20-40 minutes, but the length of exposure depends on the procedure being done. Closed images tend to produce higher quality images, and surgeons and other physicians about to perform a procedure often prefer closed MRI images to open MRI images, but not always. Closed MRIs may be preferable with deep tissue scans in helping to discover pathology. This is due to a greater Tesla Strength (1.5T – 3.0T) that is generally available in Closed MRIs. Closed MRIs may have a decreased scan volume compared to an Open MRI. The major drawback of closed MRIs is that they can cause claustrophobia, as staying still in a closed space for 20-40 minutes can be difficult for some patients. Once again, your doctor will order the appropriate imaging for you depending on your individual medical needs and injuries.

CERVICAL [Neck] MRIs: If you have been injured in an automobile accident, there are very specific reasons for MRI images to be performed that may provide important objective evidence of injury in your case. Specifically, MRI images are often ordered for those who experience continued localized pain in the neck or upper shoulders, or for a patient experiencing radiating pain down one or both of their arms (called Radiculopathy), or numbness and tingling down the patient’s arms or in their fingers or hands (called Neuropathy). These and other sensations are caused by damaged cervical discs that have bulged, protruded, or herniated in your cervical spine, causing narrowing of your spinal canal or impingement of the spinal cord (called Stenosis) or impingement of the exiting nerve roots from the spine (sometimes referred to as Neural Foraminal Stenosis or Narrowing). Here is an MRI Image showing a cervical disk bulge:

CT SCANS:  CT scans are often used in Emergency Rooms, and do well revealing both bone and ligament/soft tissue, although soft tissue images are usually not as clear as an MRI. CT scanners send x-rays through the body as it moves through an arc taking many pictures and seeing different levels of density and tissues inside the body, including solid organs, and other parts of the body. CT scans are high in radiation, and links to cancer (as many as .4% of all cancer patients in the future) have been predicted by at least one study involving CT Scan radiation. Therefore, MRIs are usually preferable to CT Scans for many injuries, however, your doctor is the best person to determine what is best for your individual medical needs. CT scans are superior in some circumstances. For example, MRIs are usually not appropriate (contraindicated) if you have certain implants, although these types of patients may be imaged with a CT. Artifacts from metallic devices, such as implantable cardioverter-defibrillators and pacemakers, may affect the image quality of CT scans. MRIs usually take longer than CT scans.

DEGENERATIVE DISK DISEASE: Often people over the age of thirty (30) start to experience degeneration of their disks, which is referred to as Degenerative Disk Disease. This does not normally cause symptoms in most people. In others, it may cause periodic mild achiness or pain, and in others, it may cause significant pain. However, under most scenarios, these disks are not as structurally sound as healthy disks and may be fragile and more susceptible to traumatic injury. A person with pre-existing disk degeneration that is involved in a car accident may develop severe or even debilitating symptoms that they never experienced before the accident. Often when an MRI is performed, it will reveal disk bulges/protrusions/herniations that were partially degenerative and asymptomatic before the accident but have now become worse and very symptomatic as a result of the aggravating traumatic event [car accident, trip, and fall, slip and fall, etc.]. It is very common to have accidents aggravate or make worse a pre-existing degenerative disk condition, making patients experience life-changing symptoms that they had never experienced before. An aggravation can have a dramatic effect on a person’s life and health, being as much or even more than a person who experiences an injury with a normal spine. Insurance carriers will almost always try to confuse the jury regarding this issue and argue that their client did not cause the disk degeneration, and are therefore not liable for the symptoms. This, however, is not the law. Under California law symptoms that are caused by an accident and the aggravation of a pre-existing condition are just as recoverable as an injury that occurred in a person with no pre-existing conditions. After all, a person with a degenerative disk condition may have lived their entire life without pain or functional loss, only to suffer serious pain and functionality after an accident. Many attorneys stay away from cases where there are pre-existing conditions in the spine. At Child & Jackson, we represent clients with pre-existing degenerative conditions all the time and are not intimidated by insurance carriers who seek to distort the truth about facts regarding those conditions. We are eager to help all of those with normal or degenerative spines and pursue both claims equally aggressively against the insurance carriers, despite their attempts to undermine those with pre-existing degenerative conditions.

IT TAKES LITTLE FORCE, ONLY ABOUT 5 MPH IN AUTO CASES, TO CAUSE SERIOUS DISK INJURIES, YET FEW ATTORNEYS HAVE THE MEDICAL KNOWLEDGE AND EXPERTIZE TO LITIGATE THIS ISSUE:  Whiplash could be seen as a traumatic acceleration of the movements beyond the normal capacity of the muscles, ligaments, and disks to handle the forces exerted as a result of a car accident, or fall. In essence, our cervical or lumbar spines “hyperflex” or “hyperextend” beyond their normal limits, causing strains/sprains of our muscles and ligaments. Sprains and strains are terms used to describe “tearing,” even at a cellular level, of our muscles and ligaments. Our bodies were designed to take only so much force. Exceed the force exerted upon the muscles and ligaments, particularly at high rates of changes in velocity, and the ligaments and muscles will tear, developing pain, capillary bleeding, scar tissue, accelerated degeneration. Often a condition arises that is so severe that surgery is required.

A flexion/extension MRI can detect the type of hyperflexion, extension, and mobility caused by a car accident, even in a person who is experiencing symptoms but cannot readily see any problems on a static MRI. Below is an example where the spinal cord compresses during flexion only. This is the type of injury that can be caused by a car accident and can cause serious symptoms, including numbness and tingling down the arms or in the fingers.

Studies show that annular fiber tears on disks can happen with as little force as 3.5gs [measured in units of gravity]. This could be as little as 4-5 mph based upon varying factors related to the change in velocity and the change in time. This is very little force, but it is applied at an awkward angle. Imagine somebody coming up behind you and pushing you between the shoulders when you were not expecting it. Your head would extend back and then go forward to catch up with your shoulders. Now think if this shove was by a 4,000-pound metal block, which is the average weight of a car. It is simply a much harder impact than most people think. People who are over the age of 30-40, depending on their degree of arthritis and degeneration, can therefore be very susceptible to whiplash, or traumatic injury to their cervical and lumbar disks, even at low rates of speed in car accidents. This is particularly true for those who already have a partially degenerated disk or disks. It doesn’t take much to aggravate the condition and/or permanently set the patient into a rapid state of decline with multiple torn annular fibers. Studies show that there is a significant increase in the rate of degenerative changes seen in patient populations that have been in auto accidents, including minor auto accidents. As many as 50% of people who have been in a minor auto accident experience pain in their cervical or lumbar spines ten years after the accident.

Insurance companies have long known about the long-term implications of even "minor" accidents. They argue that people could not be injured in light-impact cases. The industry has a name for mild impact cases: “Mild Impact Soft Tissue” or MIST cases. Many attorneys will not take MIST cases because the insurance carriers will often spend more on expert fees than the case is worth. The insurance companies use defense experts who make hundreds of thousands of dollars a year testifying for insurance defense companies. They treat people who claim Whiplash injuries like gold diggers, fakers, liars, or whiners. Nothing could be further from the truth. With the right objective diagnostic studies, our firm can show the jury where the person is injured, and help jurors understand the science, medicine, and biomechanical mechanisms for these injuries. Human beings were simply not designed to take serious flexion/extension impacts to their spines unexpectedly. Surprisingly, many lawyers do not understand medicine and science well enough to fight the insurance carriers on Whiplash injuries. We will RELENTLESSLY fight on these issues for you because we care about you, your life, and your recovery.