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The Importance of Diagnostic Studies

MRI Diagnostics

When you have been injured in an auto accident or slip/trip and fall, there are some basic diagnostic studies that can critical in objectively verifying your injuries.  These can be essential in a case where there are persistent complaints of pain or symptoms, and the insurance carriers are skeptical and employing their established tactics and well-paid defense experts to undermine your medical condition.  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.

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 MRI machines tend to be shaped like a donut.  See IMAGE.

Closed MRI Machine
Closed MRI Machine
Open MRI Machine
Open MRI Machine

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 with 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.

OPEN MRI machines are open on the side and look like two giant horizontal magnets connected on one side.   See Image.

Open MRIs may provide a significantly higher level of patient comfort, reducing the claustrophobia experienced by some patients in closed MRIs, especially large patients.  This comfort may allow patients to hold still longer, reducing false artifact and producing greater clarity on the images.  Open MRIs also have greater flexibility in placing critical body parts directly under the magnet (easier flexion/extension studies, for example).  Open MRIs may have lower Tesla Strengths (generally .7T-1.2T), however, the Tesla Strength is only one of many components and factors affecting the quality of the image, and may not affect the overall quality of the scan at all depending on the location of the study.  The scan volume may be greater with an Open MRI and may allow for a more comprehensive exam depending on the desired results by your doctor.  Open MRIs generally have lower upfront costs compared to their Close MRI counterparts, but not always.

MRI of Cervical Disk Bulge
MRI of Cervical Disk Bulge

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 disks 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 existing nerve roots from the spine (sometimes referred to as Neuroforaminal Stenosis or Narrowing).  Here is an MRI Image showing a cervical disk bulge:

LUMBAR MRIs:  Low back disk injuries, including disk bulges, protrusions, herniations, and extrusions, can also occur due to a motor vehicle accident or slip/trip and fall.  Much like the cervical spine, as the annular fibers tear in an accident, the disks bulge or protrude into the spacing around the spinal cord, or upon the cord itself, causing spinal stenosis.  The disk bulge or protrusion may also encroach upon exiting nerve roots in the lower back, causing pain or numbness/tingling sensations down one or both of the legs.   Here is an MRI image showing a lumbar disk bulge:

Lumbar Disk Bulge - MRI Image
Lumbar Disk Bulge - MRI Image

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, seeing different levels of density and tissues inside the body, including a solid organ, 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.  Artifact from metallic devices, such as implantable cardioverter-defibrillators and pacemakers, may affect image quality on 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 in nature 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 didn’t cause the disk degeneration, and are therefore are 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 normal person.  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 degenerative 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.

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