California Personal Injury – Spinal, Neck and Back, Injuries

The neck and back injuries are probably the most prevalent injury that is seen in the automobile accident.  They are also seen in pedestrian accidents, slip and fall accidents, bicycle accidents, truck accidents, motorcycle accidents, etc.  However, so many of these types of injuries have their own uniqueness and subtleties.

Soft Tissue Injury – a problem with nomenclature

For the less serious neck or back injury, these are often referred to as soft tissue injuries.  They are called this because the part of the body that has been injured, is not bone, but most often a muscle and/or a tendon.  Bone, of course, is hard tissue.  The problem with this nomenclature however, is that one of the more significant neck or back injuries, is an injury to a soft tissue part of the spine, and that is the inter-vertebral disc, and/or a nerve, or nerve root.  These are also soft tissue, but in the legal community when the attorneys discuss soft tissue, or refer to the injury as one of soft tissue, it is generally a sprain or strain of the neck and/or back muscles and/or tendons.

Matters regarding “Treatment” and “Over treatment” and Perceptions

The soft tissue injury is generally treated with medication (e.g. anti-inflammatory and/or pain relief), and physical therapy or chiropractic care.  The treatment can last from a few weeks to a few months.  In the context of litigation, and depending on the nature of the accident/incident, where the medical bills for the soft tissue injury become very high, the case is very difficult to resolve by way of settlement.  If the case does not settle, it is sometimes difficult for the jury to overcome what may be seen as “over treatment”, or what the defense may refer to as a “build up”. In recent years the size of the settlement, and/or the size of the jury award in these so called soft tissue injuries, has decreased, in large part due to the perception that when a lot is paid, everyone pays for it, in an increase in their insurance premiums.
Whenever there is a soft tissue injury however, the attorney, the client, and the treating doctor have to be on the look out for the more serious injury, such as an injury to the disc, and/or a nerve root. The most significant complaint or symptom will be a complaint of numbness or tingling in the fingers, hand, or arm.  When this complaint is noted, it is often due to some irritation of a nerve root.

Understanding the Spinal, Back and Neck, Injury

The anatomy of the spine is such that coming down from the brain is the brain stem, which goes into the vertebral canal, and it is then referred to as the spinal cord, now in the spinal canal. The spinal cord is protected by the vertebral bones, the back of each bone is what we can all feel in our back.  There are usually 26 to 33 of these bones, each with a hole in the middle, through which the spinal cord runs.
As the spinal cord runs down the middle of these bones, the spinal cord branches out from in between each of the 26 bones, and at the branching out, the cord is referred to as a nerve root.
Each nerve root then goes to a certain part of the anatomy, and is then said to enervate that part of the body.  For example,  in the neck, there are 7 vertebra, each referred to as C1, C2, C3, etc.  The nerve root that exits between the C5 and the C6 level is referred to as the C6 nerve root, and it enervates (or goes to) the thumb.  Thus when you have a complaint of numbness in the thumb, it may be due to an irritation of the nerve root, at the C5-C6 level, in or near the spinal canal, at the vertebral bone at that level.
The question then becomes what is irritating the nerve root.  An MRI is used, along with a physical exam, to see what might be causing the irritation.  The medical professional may want to consider if it is an “intervertebral disc”.  In between each of the 26 vertebral bones that we noted above are soft tissue parts called “discs”.  They are like a jelly donut.  If these herniate (bulge out), then can touch or impinge upon a nerve root, and when they do, the result is a complaint of numbness and/or tingling, and of course pain.  Because the professional knows where the complaint is, he is then able to approximate which disc is the problem.
This “herniated” disc, (or sometimes called “a slipped disc”) is treated with anti inflammatories, physical therapy, and if all of this does not work, then surgery.  Surgery can take many forms, from removal of a part of the vertebral bone, to removal of the disc (discectomy) and fusion, including the installation of hardware.
The lesson to be learned here is that sometimes these significant symptoms don’t arise until later, and what started out  as a “soft tissue” injury, may develop into a serious disc injury.  A settlement too early might be a mistake, and the failure to catch the significant symptom/complaint can also be a mistake.