Spine Injuries 101
Spine injuries are some of the most common injuries we see in motorcycle accidents, car accidents, bicycle accidents and slip and falls. But many people do not know much about the spine. Spinal injuries vary in intensity – from a bulging disc that could be causing zero pain, to herniated disc(s) that might be pressing against your spinal cord or a nerve root ending causing numbness, tingling, radiating pain and, in the most severe cases, paralysis.
Basic Spine Injury Medical Terms
Below are some of the common spine medical terms you will hear related to a spine injury.
Lordosis – curvature of cervical
Kyphosis – curvature of thoracic
Lordosis – curvature of lumbar
Spondilolithesis – slipped disk (usually degenerative, rarely traumatically induced unless its an exceptionally high-energy impact).
Intervertebral Discs – these are the cushions in between verebral bodies that make up your spine. They are the shock absorbers of the spine allowing for greater mobility and range of motion. For more discussion of basic spine anatomy, click the link.
Glucosamine keeps intervertebral discs (IVD) hydrated. IVDs are similar to ligaments because they connect bone to bone, but different in that they have a very limited blood supply. The surrounding endplates have very tiny vessels that help give nutrients to the IVD and takes away waste.
The IVD has layers of concentric circles that act to absorb and dissipate force and contain the nucleaus pulposa (which has a lot of water in it). Compressing the IVD forces water into the bone because it is a noncompressable material – think belly flop effect….if you put pressure on it, it has to go somewhere. If the force/pressure is too great, you get a herniation.
We tend to see more cervical and lumbar injuries in car accident and other personal-injury cases, because those areas of the spine are way more mobile, whereas the thoracic area is really held tight by the rib cage.
- Interestingly, ½ of all cervical motion (making the yes movement with head) is in C1-2. But you don’t see a lot of injuries between C1-4 because the lower levels are whats called transition points. There is lots of motion above C5-7, zero motion beneath (because thoracic levels are held in place, supported by the ribcage)…so the lower cervical spine levels absorb the brunt of the force and are more likely to be injured.
Annular tear – (also called a Rim Lesion) without herniation can still cause severe pain because pain fibers penetrate through the annulus. Most doctors view an annular tear as a soon-to-be herniation. To read more about herniated discs, click the link.
Osteophytes – do not come about in a matter of days. It’s the body’s response to ongoing stress and damage and takes a significant amount of time to appear (can be after an accident, which is why its important to have MRIs done relatively shortly after the accident…and maybe again some months later).
Myelopathy – refers to problems concerning the spinal cord. Cervical nerves give us strength and movement in our arms. When impinged, you have myelopathy which can result in a multitude of problems.
Nerves are like a flimsy piece of spaghetti. So when its touched or compressed, can lead to pain and other problems of varying severity.
When To Get Spine Surgery?
Theoretically, spine surgery is simple – it is designed to solve two types of problems:
- Instability: treat by fusing or replacing the problem disc
- Compression: treat by decompressing
What is Replacement Surgery?
Replacement surgery involves removing the natural intervertebral disc and replacing it with an artificial disk, designed to mimic the motion of the cervical spine (replacing lumbar discs has fallen out of favor in the medical community. There were a significant increase in medical malpractice cases involving a lumbar replacement that popped out several months after the procedure). This also has the benefit of keeping relatively good cervical range of motion and discourages adjacent disc disease (although nothing is as good as the real thing).
What Is Fusion Surgery?
An orthopedic spine surgeon inserts a structure between the two vertebra (made of plastic or metal) to encourage the bone to fuse together to stop motion.
Fusion is a highly successful procedure. But in the cervical level, if young enough you also want to do the disc replacement. Fusion alone brings a high likelihood of adjacent-disc disease (other discs compensate by carrying the extra burden and will degenerate faster).
Future medical treatment after a fusion: the idea is always to return the body to a state of normalcy as much as possible, which is why replacement is favored over a fusion alone….but all these materials inserted into the body have a lifespan…something we keep in mind.
For more discussion on whether or not to get surgery for a herniated disc, click the link.
Intervertebral Disc or Facet Joint Injury
The problem can be with the disc or the facet. General Rule of Thumb: if you have more pain while sitting for long periods: disk problem; more pain while standing for long periods: facet problem.
Myelogram – a good secondary study to an MRI. The absence of dye shows the herniation.
If looking forward in an auto accident, facets hold up really well. If looking to the side, facets are more easily damaged.
Rhizotomy – rhizotomy or ablation procedures are for facet problems only. Injections/facet blocks will always only produce temporary relief. But they are good diagnostically because if a doctor sees a facet block as helping the pain, he/she can be confident that a rhizotomy will almost completely eliminate the pain forever or for a sustained period of time.
Another often-overlooked condition is Sacro-Iliac Joint Dysfunction. 1/3rd of those with back pain have SI joint dysfunction. Its hard to diagnose because it wont show up on an MRI. If there is a normal MRI and the patient is still miserable we know to look at the SI…if pain medicine injection relieves the pain, a diagnosis if sacro-iliac joint dysfunction is an appropriate diagnosis.
SI joint dysfunction pain is commonly seen in slip and falls where the slip and fall client falls backwards, landing on the buttocks. SI pain is also elicited in car accidents because the pelvis or SI joint is locked in place. We are more likely to see SI joint dysfunction pain on the right side because the right foot is pressed hard against the brakes.
If you have been in a car accident or slip and fall, it is important to immediately seek medical attention and then reach out to a personal injury attorney.