My name is Dr. Scott Farley and I’m an orthopedic spine surgeon. The question we are going to be discussing today is “Was my disc herniated from an accident?”. This is a very complex and sometimes is a difficult conversation because there are a lot of nuances to this. There are many resources online that will discuss disc herniations, car accidents and lots of information regarding patients, between the ages of 40-80, routinely having disc herniations and bulges not being from accidents but from degenerative changes.
We are going to talk about how disc herniations relate with motor vehicle accidents and what was someone’s history prior to the accident? Did they have any pain? Did they have any record of pain? Have they been treated by a doctor, chiropractor, pain management doctor seen a surgeon, missed work, etc.? So again, this is a time related issue. There is an incident that occurred that presumably changes someone’s life. Now the question is “What is causing that pain from that accident or incident?”. Many will have you believe that it’s not possible to have a disc herniation after a traumatic event. This categorically doesn’t make sense nor is it true. You would have to have an MRI right before and then after an accident to determine if there is a change in this short frame of time. Now realistically, this doesn’t occur very often. From an MRI after an accident, we cannot really tell the acuity when a disc herniation occurred, that is not possible. So we have to use our clinical judgement as a spine surgeon. We have to get the proper information from the patients, we have to understand their history and their pain.
Now in a lot of the information that I’ve been seeing online, if a disc herniation occurred acutely, you’d expect as they say in quotations “pain shortly after the incident”. What does shortly mean? This is the main point of this, is that shortly within two minutes or two weeks? I would say that everybody is an individual, everybody is different, everyone is going to respond from an accident differently. So I think that when they use the word shortly it’s important to try to define what that means and I’ll tell you what I think that means. I have extensive history dealing with patients with spine pain and disc herniations. Shortly would mean within the first few weeks. Clearly if there is a large disc herniation, it might occur in the first five minutes. I can tell you in my practice, I routinely see patients who injure their discs that start having increasing pain shortly after, meaning within the first few hours to then progressively becoming significant within the first few weeks. Again, bodies don’t read a textbook. They don’t have that it has to happen in a certain way. I have patients who have large disc herniations, 5, 6, and 7 mm that don’t have very much pain at all. I have patients who I believe have 2mm disc herniations and are in significant pain. So this goes to the experience, education and training of the provider seeing the patient. Which requires, as we have been talking about, taking down the history, doing a physical exam, looking at the images and putting this information together. Now as you would imagine, in the spine and the neck and the lower back, the disc is very close to many structures that can cause pain. Meaning the facet joints, numerous ligaments, facet capsules and muscle insertions that all have the ability to produce pain. I think it’s even more important to understand the fact that if you’ve had an MRI and you’re told that there is a disc protrusion or bulge then this is too simplistic. Pain occurs from the back fibers of the disc that can just be disrupted. The disc can be torn and causing pain where there are pain fibers. Given the tight compacted nature of the disc in relation to the joints, ligaments and muscles. Patients routinely will have pain from all of these sources. There’s a percentage of pain from the joint, percentage of pain from the disc, percentage of pain from the ligaments and also pain generated from the muscle. So leaving my office, I would have someone routinely coming in thinking and believing that only their pain maybe coming from the disc, which is possible. But then I also have people understanding with the use of their MRI, their physical exam and the model of their spine that they are also likely having pain not only from the disc, from the joint, from the soft-tissue muscle insertions and the ligaments.
I think it’s important to understand the timing from the accident, the timing of when pain is possible. You could think of it this way, if you go to the gym and you worked out and you haven’t worked out in a really long time. You would have sore muscles the day after you worked out but really sore muscles two days after your workout. I call this the “After Workout Soreness Phenomenon” the same is true with an accident. When you’re in an accident and you’re in the emergency room, you’ll be focusing on your most significant pain. Typically patients will go home and in the first few hours they’ll have increasing soreness. They’ll wakeup having soreness in body parts that we ’rent even bothering them a few hours before. Then two days later be having pain in parts that they didn’t even have the few hours before then. So the pain changes, the stiffness changes and the symptoms change. So this is an important fact that everybody that has experienced an accident or a trauma would understand. I think the other important fact for you to understand is that when you’re being seen by a clinician, the information provided there is significant. We see a patient, we see your physical exam, we have the ability to talk, look at the whites of the eyes to see what their life was like before and after the accident. We look at the MRI with the patient and synthesize that information. As you can see from other online information, people will say that you can’t have pain from a disc herniation starting two weeks after, that it has to be within the first few minutes. That because you didn’t have pain in your neck when you were seen in an emergency room a few hours after the accident it’s impossible to have pain in other body parts. This is clearly not the case. So in a litigation type situation or a workman’s comp type of situation, it becomes clear that unfortunately patients have a peer to peer review, a paper review from another doctor. They don’t have the ability to see the patient. They typically don’t have access to the MRI, they’re simply looking at the records and making a medical opinion. I believe that any of those types of providers that have the same information I had, the same experience, education and training that I had, that they couldn’t help but come to the same conclusion that I’m having. And so again, a paper review is so limited and only gives a small window into a patient as an individual and actually how their life is affected, what the physical findings are and what their MRI shows. It would be impossible to make a true, good medical opinion, diagnosis and forming a treatment plan simply by looking at paperwork.