By Brian R Wilson, Esq.
Car collisions can frequently cause injuries to the lumbar and cervical spine. When the spinal discs or "shock absorbers" of the spine are injured, it can mean pain, immobility, numbness down a limb, and even require therapy and surgery. Anyone who's ever had some sort of spinal disc injury can attest to the pain they can cause.
But what's the difference between a bulging, herniated, extruded, or torn spinal disc? In a recent trial I had in an auto collision case, a local chiropractor did an excellent job of explaining the difference between the various forms of injuries to spinal discs, which you can read below:
16 Okay. Thank you. So have we covered all
17 the fractures then?
18 A. I believe so.
19 Q. All right. Let's move to other injuries or
20 conditions that you discovered in ______'s
22 A. Okay. The --
23 Q. Go ahead.
24 A. We did a standard orthopaedic neurological
25 examination when she first entered our office.
1 This examination is designed to allow me to provide
2 a working diagnosis, which is what the problem is,
3 what's generating the pain, what's the pain
4 generator. And on this examination we saw greatly
5 decreased range of motion in the lumbar spine and
6 in the cervical spine, pain on motion, orthopaedic
7 tests, which were designed to let me know, again,
8 how severe the injury is, is it just a pulled
9 muscle, a strain/sprain, a pinched nerve. Some of
10 them were -- she was in too much pain to perform
11 them. There were two orthopaedic tests that led me
12 to believe that she may have a herniated disc in
13 her lumbar spine. Specifically Kemp's test and
14 Valsalva's test.
15 Along with that, she was experiencing
16 radiating leg pain. Because of those findings, I
17 ordered immediately the MRI, and the MRI did show,
18 along with the pelvis fracture, it showed herniated
19 discs in the lumbar spine level. The herniated
20 discs were classified as extruded in nature and
21 they were at L3/L4, L4/L5 and L5/S1.
22 Q. Okay. Could you show us on the model.
23 A. Yes.
24 Q. And then explain to us what an extruded herniated
25 disc is.
1 A. Okay. Your discs are the shock absorbers in
2 between each vertebrae. They're designed for low
3 transfer and for support. They're made of mostly
4 water. They're soft tissue. A herniated disc is
5 when enough pressure is on that, that it will want
6 to come out. In layman's term, a slipped disc. A
7 bulging disc is the beginnings of a herniated disc.
8 The red on this picture is a herniated disc, on
9 this model, if you can see that.
10 Q. Okay.
11 A. On this model here, this might be a better model,
12 the red bulging out here is a herniated disc.
13 Q. All right.
14 A. Okay. The danger is, it will come out really close
15 to this nerve and it will pinch.
16 Q. And it will break off?
17 A. It will break off. A nerve's like overcooked
18 spaghetti in real life. It only takes the weight
19 of a quarter to cause 60% nerve malfunction. It
20 doesn't take much weight. So an extruded disc is a
21 disc that is bulging even further than most, and --
22 can I use my board now?
23 Q. Absolutely.
24 A. This would be a good time to explain this.
25 MR. WILSON: Let's go off the video.
1 (Off the record discussion was held)
2 A. Okay. On disc, if we have a normal disc, looking
3 at it from top to bottom, and that would be like
4 this, (Indicating). If I'm looking at this
5 vertebra like this, there's the disc, this is the
6 disc. A normal disc would have no type of bulge or
7 deviation around there. It would be nice and it
8 would be smooth and round. If we have a bulge,
9 then we're going to start to see this right --
10 right there, and a radiologist will measure this to
11 determine if it's a bulge or if it's actually a
12 true herniation. So this is a bulging disc.
13 Then as we get worse, we have what's called
14 a protruded disc. Now the bulge has grown more,
15 and there's a measurement from here to here.
16 (Indicating). They measure how long it is here and
17 how deep it is here, and then that measurement
18 tells them if it's a protruded disc or not. That's
19 the first stage of a herniated disc, okay. You
20 would have a nucleus in the middle, and it's
21 wanting to come out, it's like a jelly-filled
22 doughnut, and it's pushing, it's pushing, it's
23 pushing out. There's our nucleus.
24 Then the next disc you would have would be
25 the extruded disc, and on the extruded disc, the
1 nuclear material pushes out, and it actually breaks
2 the annular fibers that holds that nucleus in
3 there. There's a tear in the fibers, which her MRI
4 report also said annular tear, so it fits right
5 along with an extruded disc. So this is a
6 protruded disc, this is an extruded disc. Then as
7 it gets worse, you get a migrating disc. That
8 extrusion will want to float or want to migrate up
9 and down the spinal column, okay. And that's
10 nuclear material. The nucleus, like that.
11 (Indicating). Then the next one, which is the
12 worst of the worst, is you have a migrating disc
13 that becomes a fragment. It broke off in there.
14 Okay. This is almost always surgery right here,
16 So out of all these discs right in here, we
17 know through studies that this extruded disc is
18 kind of special because it takes a trauma to cause
19 it. Studies show that a majority of patients might
20 have a herniated disc and not know it and live
21 asymptomatically. That's true for a protruded
22 disc, but for an extruded disc, when there's a
23 annular tear, there's almost always over 90%, 95%
24 chance that there was a trauma that happened that
25 caused it, meaning a person will know if something
1 happened for that to occur. They weren't just
2 living with it and then all of a sudden it creeps
3 up and comes on when they bend or twist the wrong
4 way. So these are the different types of herniated
5 discs. And our patient had three of these, at
6 L3/L4, L4/L5 and L5/S1 on the MRI.
7 Q. Thank you.
8 A. Thank you.
9 Q. Let's return you to your seat so you don't have to
10 stand there.
11 (Off the record discussion was held)
12 Q. Generally speaking, what kind of problems can an
13 extruded disc create in patients?
14 A. Well, it depends on how much pressure's on the
15 nerve root. If there's a lot of pressure on the
16 nerve root, it could be anything from just slight
17 numbness or tingling down a leg or down an arm, to
18 loss of bowels control, a loss of bladder control,
19 loss of leg function, loss of muscle function. It
20 all depends on how much pressure is on that nerve.
21 It only takes the weight of a quarter of pressure
22 to cause 60% nerve malfunction. So it's important
23 to try to get that disc off as soon and as fast as
24 possible and to start the healing process as fast
25 as possible to make the strongest repair, strongest
1 scar formation, so that it won't do that. That's
2 why we ordered the MRI as soon as we did.