by Dorothy C. Sims, Esq.
Trauma, no matter how mild, has the potential of aggravating or worsening any pre-existing degenerative disease of the spine. Often the defense medical expert will claim all symptoms of a back injury are due to a prior degenerative disc disease. This may be claimed in spite of the fact that either the patient was completely asymptomatic before the trauma or the symptoms worsened significantly immediately after a trauma.
References.
“It has been reported that pre-existing degenerative changes, “no matter how slight,” adversely affect the prognosis.” SOURCE: Norris SH, Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone Joint Surg. 1983; 65B: 608-611
“Chronic neurological sequelae develop after a single acute or multiple chronic traumatic episodes to the cervical spine and spinal cord.” SOURCE: Richard C. Schneider and Robert Knighton . Chronic Neurological Sequelae of Acute Trauma to the Spine and Spinal Cord: Part III The Syndrome of Chronic Injury to the Cervical Spinal Cord in the Region of the Central Canal. J. Bone Joint Surg. 1959; 41:905-919
“The high incidence of cervical osteoarthritis and spondylosis observed in those presenting years after acceleration/deceleration injuries suggests a very strong causal relationship, especially when the disease is localized to one or two levels”. SOURCE: Foreman Stephen M., Croft Arthur C. Whiplash Injuries : The Cervical Acceleration/Deceleration Syndrome. 2nd edn. Philadelphia, Lippincott Williams and Wilkins, 1995 p-340
Although we suggest that mechanical loading precipitates degeneration, the most important cause of degeneration could be the various processes that weaken a disc before disruption, or that impair its healing response. The combined effects of an unfavorable inheritance, middle age, inadequate metabolite transport, and loading history appear to weaken some discs to such an extent that physical disruption follows some minor incident.
A common example is that of disc herniation following a cough or sneeze. It could be argued that such a weakened disc should be considered degenerated, even if it remains structurally sound. However, a disc is unlikely to become painful until it becomes disrupted, so there is little to be gained by anticipating future events and applying the term “degeneration” before this crucial nonreversible event actually occurs. As suggested previously, accelerated biochemical or cellular events in a structurally sound disc could be designated “early degenerative changes” to distinguish them from changes that are entirely typical of the disc’s age. The multifactorial nature of disc weakening suggests that, from a medicolegal standpoint, all discs are “vulnerable” to a greater or lesser extent, and the vulnerability can only be gauged from the violence, or otherwise, required to disrupt the disc and initiate degeneration.
The underlying cause of disc degeneration is tissue weakening occurring primarily from genetic inheritance, aging, nutritional compromise, and loading history. The precipitating cause is structural disruption occurring from injury or fatigue failure.
Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it?
Spine. 2006 Aug 15;31(18):2151-61. Review.
“When symptoms are more severe or progressive despite the use of a collar and when they occur in younger patients, operative treatment may be necessary”. SOURCE: Way Lawrence W, Doherty Gerard M. Current Surgical Diagnosis and Treatment. McGraw Hill 11th edn 2003, New York, p- 1209 }
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