The back is a complicated structure of bones, muscles, and other tissues extending from your neck to your pelvis. Back injuries can result from sports injuries, work around the house or in the garden, or a sudden jolt such as from a car accident, trip and fall accident, or in a truck or bus accident. Some back injuries or pain can even begin with something as routine as a cough or sneeze. The lower back is the area of the spine which is most frequently injured, and which is the most common site of back pain.
The spine is comprised of bony structures called vertebrae. In between the vertebrae are soft discs filled with a jelly-like substance. These discs provide cushioning for the vertebrae and keep them in position. When a person develops a herniation (or to a lesser extent, a bulge), this means that the disc has ruptured or moved (“slipped disc” is another expression commonly used). If the “slipped” or herniated disc is pressing on a nerve, that can cause pain, numbness or tingling. In the lumbar spine, this is sometimes called sciatica when the pain moves from the back down the leg into the thigh or buttock. Herniated discs are more frequent in the lower or lumbar spine. Herniations are least frequently seen in the thoracic (mid-back) spine.
As we grow older, the discs in our spine weaken, become flatter, and do not provide as much cushion due to “desiccation” or drying out of the disc material. If a disc becomes very weak, the outer part can tear. The inside of the disk can then protrude through and press or impinge on the nerves adjacent to it, causing pain, numbness, and tingling.
Herniated discs in the lower or lumbar spine will frequently cause the following:
- Pain down the leg or into the buttock;
- Numbness or tingling down the leg (or both legs in bilateral herniations);
- Muscle spasms or weakness in the lower back, legs or feet.
Herniated discs in the upper or cervical spine will frequently cause the following:
- Pain down the arm or into the hand;
- Numbness or tingling down the arm (or both arms in bilateral herniations);
- Muscle spasms or weakness in the neck, arms or hands.
Physicians, chiropractors and other medical professionals diagnose many lumbar and cervical injuries, including herniated and bulging discs, through the use of an MRI or CAT Scan. MRI stands for magnetic resonance imaging, a scan that utilizes an imaging method with powerful magnets and radio waves to create images of the area of the spine (or other part of the body) being examined. An MRI does not use radiation, and the images are known as “slices”, which can be stored on a computer and produce multiple images.
Alternatively, herniated discs and other injuries or diseases of the spine can be diagnosed using a CAT Scan. This stands for “computed tomography”, and is an imaging method which uses x-rays to develop cross-sectional pictures of the lower back or other areas of the body being examined. In a CAT Scan, the patient lies on a narrow table that moves into the center of the CT scanner, where X-ray beams rotate around the patient.
The CAT Scan also creates slices of the area of the spine being visualized. These images can be stored, viewed, or printed on DVD’s. Additionally, 3 dimensional models of the spine can be made by stacking the slices together.
The most frequent back injuries include:
- Fractured vertebrae;
- Herniated Discs of the lumbar (lower back), cervical (neck) or thoracic (mid-back) spine;
- Bulging discs of the spine;
- Lumbar (back) or Cervical (neck) strain or sprain;
- Sciatica or nerve pain from the lower back down the back of one thigh and into the calf.
These injuries are the cause of pain and often result in limited movement or restricted range of motion of the spine. Treatments include pain medication; heat or ice treatment; bed rest; acupuncture; chiropractic care; epidural injections into the spine, physical therapy or surgery. It is generally accepted that some back injuries or pain might be prevented by maintaining a healthy weight, lifting heavy objects with your legs, and using lumbar support devices when you are seated.
A lumbar or cervical sprain is a stretched or torn ligament in the affected area. Ligaments connect bones at the joint. Generally, sprains occur as a result of falling, twisting suddenly, or falling, twisting, or getting hit by an object. Symptoms of a sprain will involve pain, swelling, bruising and reduced ability to move that part of your body.
A lumbar or cervical strain is more of a stretching injury, in which the affected muscle or tendon is stretched, twisted, or torn. Tendons connect muscle to bone. Strains occur suddenly or can be more chronic, which means over a period of time. Lumbar strains are very common, and can occur playing sports or lifting heavy objects. Pain, muscle spasms, swelling and reduced range of motion are all possible symptoms of a lumbar or cervical strain. Treatment for strains includes ice, wearing a brace or other device which compresses the area, exercise, chiropractic care, physical therapy, acupuncture and pain medication, among others.
More severe injuries to the back include spinal cord injuries, which can be caused by a trauma that dislocates or fractures the vertebrae. The trauma or impact can cause pieces of vertebrae to tear into the spinal cord tissue or impinge on surrounding nerves. If there is what is known as a complete spinal cord injury, the cord cannot send messages to areas of the body below the level of injury, resulting in paralysis. If there is incomplete paralysis, there may be some sensation and movement below the level of injury.
More significant treatment for injuries and diseases of the spine, to treat symptoms including severe pain, numbness, tingling, and loss of range of motion of the spine (and often utilized as a last resort) involves surgical procedures including:
- Laminectomy, in which the lamina, which is the part of the bone which comprises the vertebrae, is removed, (disc fragments or bone spurs are what is generally removed) in the hope that this surgical procedure will lessen pressure on the spinal nerves or spinal canal, thereby reducing or eliminating pain, numbness and tingling in the affected areas of the spine and extremities (arms or legs).
- Foraminotomy, which is surgery to widen the opening in the back where nerve roots exit the spine, or where there is narrowing of the nerve opening, known as “stenosis.” The goal of a foraminotomy is to relieve pressure from a nerve in the spinal column, hopefully reducing pain and allowing the nerve to move more freely.
- Diskectomy, in which the portion of a disc which has protruded through and is now impinging (“pressing”) on the adjacent nerves is removed with the goal of reducing or eliminating pain, numbness and tingling of the affected area of the spine and extremities.
- Spinal fusion, which is a procedure in which two bones are fused together in the spine. This can be done using hardware, including rods, screws and plates, (known as “open reduction internal fixation or “orif”); by using what is known as an interbody cage, which contains bone graft material; or the fusion can be performed with bone graft material from another part of the body (such as the pelvic bone), called an “autograft.” Additionally, the graft material can be synthetic, or from a bone bank, called an “allograft.” A frequent area of the spine where a fusion is performed is between disc levels L4 and S1, meaning the fourth lumbar disc and the first level of the sacrum.
Generally speaking, a laminectomy, diskectomy or foraminotomy will be tried first before a spinal fusion, which is a more complicated and lengthy surgery with more risks.
Due to the complexities and variety of lumbar and cervical spine injuries and conditions, it is critical that you retain a back injury attorney with the knowledge, experience, background and dedication to ensure that you will be compensated for all of your injuries and damages, including your physical and emotional injuries, loss of earnings and earnings potential, medical and hospital expenses (past and future) and loss of enjoyment of life. We represent clients in state and federal Courts in the Bronx, Brooklyn, Manhattan, Queens, Westchester, Rockland, Putnam, Orange and Dutchess Counties. Contact the Back injury lawyers online or at (914) 428-7386 for your free initial consultation today to discuss your case in specific detail.