A large percentage of automobile accidents include whiplash injuries. Whiplash is a layman’s term. It is more descriptive of the mechanism of injury than it is medically diagnostic. The sudden forward and backward jerking of the head in an automobile accident can put extreme strain on the spine and cause permanent injury, which sometimes requires surgical repair. Medical descriptions of this type of spine injury are more meaningful when the anatomy of the spine is understood. Many of our clients tell us that they better appreciate what their doctors told them about their injuries after hearing the description below.
The spinal column is a stack of 24 vertebrae (bones), with discs between them, held together by ligaments and muscle. Discs, considered soft tissue, have a tough fibrous perimeter and a soft, Jello-like, water-absorbing center Discs allow vertebrae to move and accommodate bending while avoiding destructive bone-on-bone contact.
A vertical hole at the back of each vertebra allows the spinal cord (nerve tissue) to run from the brain to the lower back. Small tunnel-like holes on each side of the vertebrae adjacent to the disc spaces, called foramina, allow nerve roots to branch from the spinal cord, providing sensory and motor function to muscles and organs throughout the body. The muscles and organs served by each nerve root are the same for everyone. Thus the nerve root in the neck coming out of the hole near the disc between the 6th and 7th cervical vertebrae (referred to as the C6-7 disc space) when compressed in or near the foramen can cause numbness, tingling, a burning sensation, and pain in the first two fingers and thumb. Doctors describe this nerve root compression and the resulting symptoms as radiculopathy. Radicular pain is a type of radiating pain because the injury is in the spine, but the pain is felt in the extremity. Most radiculopathies originate in the neck (cervical spine) or lower back (lumbar spine). Radiculopathies originating at the chest level (thoracic spine) are less common. Most people who have experienced radicular symptoms describe them as unique, unlike any other pain.
Pressure on the nerve root has several causes. The source of the pressure often determines the medical treatment required. Some patients are simply experiencing aging spines (degeneration), which often includes the narrowing of the foramina caused by gradual calcification (osteophytes) or disc thinning (desiccation) or both. Surgical repair is seldom recommended in these situations.
Severe, traumatic whiplash often causes discs to bulge or rupture. A bulging disc can apply pressure to the adjacent nerve root resulting in unmistakable radicular symptoms. A ruptured disc, also called a herniated disc, is more severe than a bulging disc because the herniation causes the disc to lose its gelatinous center thereby becoming thinner. In addition to disc thinning making the foramen spaces smaller (a condition known as stenosis), ruptured discs will often deposit disc material in nerve-irritating locations. The solution to severe disc damage cases usually includes surgical removal of the damaged disc (discectomy) combined with fusion of the vertebrae above and below the irritated nerve root. The fusion opens the foramen and holds it there so the nerve root is no longer irritated by debris or body movement. Discectomy and fusion surgery is the recommended treatment in these situations, because unlike many other body parts, discs do not regenerate or otherwise heal themselves.
In recent years, the cost of discectomy and fusion surgery has ranged between $60,000 and $80,000. Remarkably, almost every patient reports that the burning, tingling, and numbness are gone when they wake up in the recovery room.
Traumatically-induced changes to discs, which can be life-changing, might not be evident until months after the trauma. An insurance company worried about the potential for expensive discectomy and fusion surgery might try to exploit the delay in symptoms by offering quick cash in return for a full release. An insurer will do this because once a claim is released, there is no going back, even if the injury turns out to be much worse than the parties realized. That is one reason to not settle a case before knowing the full extent of the injury and future medical needs.