What Happens When Your Neck or Back Injury is More than "Whiplash"


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Car Accidents and "Whiplash"

When two cars collide, direct impact forces or rotational forces are applied to the cars and their occupants.  Whether the vehicle you are in is struck from the rear or the side, the forces applied to your body can cause significant damage to your spine (neck and back).  When your neck or back is forced into a quick movement, flexing or extending beyond its normal range of motion, the muscles, nerves, ligaments and tendons are stretched and or twisted causing a sprain or strain of the soft tissue structures surrounding your spinal column.  This quick flexion/extension movement or injury has been called "whiplash."  Simple "whiplash" may only cause a sprain or strain of the muscles of the neck, shoulder or back, however, sometimes the force applied to your body results in greater harm that will not resolve in a few short weeks.

What is a Herniated Disc?

The spine is composed of a series of connected bones called "vertebrae."  The vertebrae surround the spinal cord and protect it from damage.  Nerves branch off the spinal cord and travel to the rest of the body, allowing for communication between the brain and the body.  The brain can send a message down the spinal cord and out through the nerves to make the muscles move.  The nerves also send information such as pain and temperature from the body back to the brain.  The spine has three distinct areas:  the cervical spine (neck); thoracic spine (mid back); the lumbosacral spine (lower back).

The vertebrae are connected by a disc and two small joints called "facet" joints.  The disc, which is made up of strong connective tissues which hold one vertebrae to the next, acts as a cushion or shock absorber between the vertebrae.  The disc and facet joints allow for movements of the vertebrae and therefore let you bend and rotate your neck and back.

The disc is made of a tough outer layer called the "annulus fibrosus" and a  gel-like center called the "nucleus pulposus."  Trauma to the spine from an impact or twisting, as occurs in motor vehicle accidents, sports injuries, falls or construction site accidents can cause the annuls fibrosus to rupture or rip open.  This can allow displacement of the disc's center which is called a herniated or ruptured disc.  The displaced nucleus pulposus or a fragment from the annuls fibrosus can move qnd press through the rupture into the space occupied by the nerves or spinal cord.  The herniated disc can then press on the nerves and cause pain, numbness, tingling or weakness in the neck, back or arms and legs.

How Does Your Doctor Determine if You Have a Herniated Disc

A thorough clinical examination to determine the character and location of the pain plus an examination of the spine and careful assessment of any weakness, loss of sensation or abnormal reflexes can often diagnose and locate a disc herniation.   Your doctor's diagnosis can be confirmed by MRI or CT Scan study.  These studies can show the damage to the anatomical structures of your spine.  Your doctor can also use an EMG/NCVstudy  to diagnose damage or the effect of the herniated disc to the nerves in your arms and legs.  A simple metaphor may be the MRI determines if the utility pole is broken.  The EMG/NCV will determine if the flow of electricty along the lines has been disturbed. 

What Treatments Are Available

Some people who sustain a herniated disc may improve after a short while without any medical care.  Some will sustain a herniated disc and not feel any manifestation for several days after the initial trauma.  Your doctor may prescribe a short period of rest, a neck collar, back support, anti-inflammatory medications to reduce the swelling or analgesic drugs to control the pain.  You may also be set on a course of physical therapy inclusive of heat, cold, massage, electric stimulation, traction and exercise.

If the course of conservative care (non-surgical) does not relieve your symptoms, you may be referred for trigger point injections or epidural or facet block injections.  Trigger point injections are injections of local anesthetics directly into the painful soft tissue or muscles along the spine.  While occasionally helpful for pain control, trigger point injections do not help heal a herniated disc.  Epidural or facet block injections are injections of corticosteroid int the epidural space - the area around the spinal nerves.  The initial injection may be followed by one or two more injections at a later date.  The purpose of the injection is to reduce inflammation of the nerve and the disc.

For people whose pain and function do not improve with the previous treatments, surgery may be necessary.  The surgeon often removes the portion of the disc that is pushing on the nerve.  This procedure is called a discectomy.  At times a portion of the vertebrae is removed to free a trapped portion of the nerve (laminectomy or corpectomy).  Sometimes, if a large enough portion of the disc is removed, the disc space is filled with an artificial disc or cadaver bone to give support to the spine. The vertebrae are then "fused" with small screws or a plate to hold the new disc in place and give the spine stability.

Herniated discs can cause tremendous pain and have a significant effect on your activities of daily life.  Be sure to seek the proper medical care and attention and follow the recommendations of your doctor.  if you sustained a herniated disc as the result of a car accident, construction site accident or trip and fall, seek legal counsel from an experienced personal injury trial attorney immediately so your injuries and medical treatment can be properly documented and presented to the insurance company and jury.

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