Our office routinely comes across injuries to the spine from Massachusetts motor vehicle accidents and work place injuries. Yes, seat belts save lives, but in a recent case involving a client of ours involved in a high speed T-bone collision in Massachusetts, the force of the impact left our client with severe back injuries, one of which was diagnosed as spondylolisthesis. What is spondylolisthesis? First we must understand the spine.
The Human Spine in General
The human spine in its structure is an amazing part of the body. It consists of thirty three separate bones and tissue that enclose and protect the spinal cord. These separate bones are referred to as vertebrae and between each vertebrae is an intervertebral disc, a band of cartilage that acts as a shock absorber adding additional protection to the spinal cord. Our spinal columns provide the main support for our bodies and allows us to perform some of our most common day-to-day activities, including standing, twisting and bending. Most importantly, this spinal structure protects the precious spinal cord from injury. Our spinal cords are responsible for the transmission of neural signals between the brain and the rest of the body.
The spine is broken down into sections, which are referred to in the medical field as “regions”. They are:
- Cervical Region: The cervical spine is the top seven vertebrae of the spine directly below the brain. These series of vertebrae are abbreviated as C1 through C7.
- Thoracic Region: Right below the cervical region are the next twelve vertebrae that make up the Thoracic Region of the spine. This is the middle portion of the spine and the vertebrae are abbreviated as T1 through T12.
- Lumbar Region: The next five vertebrae make up the Lumbar Region. These are the largest and strongest of the vertebrae and are abbreviated as L1 through L5.
- Sacral Region: Then there is sacral region, which is located right behind the pelvis. The sacrum consists of five bones, abbreviated S1 through S5. These vertebrae are fused into a triangular shape and connect the spine to the pelvis.
Just below the sacrum are five more bones that are fused together to form the tailbone, which is called the Coccyx. The Coccyx makes up the base of the spine.
Spondylolisthesis is a Very Common Back Injury Seen in Personal Injury Cases
One major types of back injury we see often at our office suffered in motor vehicle accidents as well as workplace injuries is spondylolisthesis. Spondylolisthesis is when one of the vertebrae of the spinal column “slips” out of alignment by moving forward or backwards on the vertebra below. It most often occurs in the lower spine, the lumbosacral spine. If the vertebra slips too far it may press or squeeze the spinal cord or nerve roots and cause severe lower back pain, leg pain, numbness and/or weakness. The muscles in your legs may feel tight, stiff and/or weak and you may even develop a limp. Most often you experience radiating pain from the lower back down the legs due to the pressure cause on the nerve roots. In rare cases it can also result in loss of bowel or bladder control. X-rays may show vertebrae that have fractured, cracked or slipped out of alignment but further testing, such as CT scans or an MRI’s may be necessary to pinpoint the damage.
There are many causes of spondylolisthesis. Our office, however, see spondylolisthesis as the result of accident or trauma. A severe rear end, head on or side collision can result in the lumbosacral vertebrae slipping out of alignment. A severe slip & fall can also be a major cause of the condition as well. Someone falling hard on their back or buttocks can have a dramatic effect on their spine. Slipping backwards on a set of stairs or falling while carrying items at work have resulted in painful and debilitating injuries to our clients.
Treatment Options for Spondylolisthesis
There are several treatment options available for spondylolisthesis. In the initial phase, generally, ceasing all physical activity that may lead to further vertebrae damage, rest and recuperation is the first approach to healing. Additionally, non-steroidal anti-inflammatory drugs such as ibuprofen and over the counter medications are routinely ordered in the initial treatment of these type injuries. Non-steroid anti-inflammatory drugs target pain and inflammation. Since much of the pain is secondary to inflammation of the nerve root, a reduction in inflammation can be of great relief under certain circumstances. Opioid medication is used when other medication fails to provide adequate relief and in many cases it is the only form of relief to injury patients. Those that have suffered significant and debilitating back injuries find no other option to relieve pain but to take opioids. We can tell you from the number of years we have been practicing and the numerous cases we have handled that turning to opioid use long term can be a precarious option due to the risk of severe addiction.
The next level of treatment would be physical therapy as a means to slowly increase movement and build up stomach and back muscles, often referred to as core strengthening. Don’t discount core strengthening as a means to address these injuries. This author believes that one reason we fall into these injuries because we’re not conditioned enough in the first place to resist impacts. Strengthening the muscles that support you spine and learning how to prevent future injuries is the philosophy behind physical therapy. Physical therapy starts off slow giving your body the opportunity to heal through a number of passive treatments such as deep tissue massage, hot and cold therapies, electrical nerve stimulation or ultrasound. Over time, though various exercises incorporated in treatment will improve your strength, core stability and range of motion.
Another very common treatment option is epidural steroid injections (or ESI). These injections usually follow in a situation where there have not been a satisfactory response to physical therapy. This minimally invasive procedure is where medicine or drugs are delivered by injection into the epidural space of the spine. The delivered drugs assist with inflammation and pain relief. Typically, these injections relieve pain to help improve the spine with physical therapy. There are many individual that respond well to epidural steroids and there is sufficient evidence to suggest that it can provide both short and long term improvement with spondylolisthesis.
Lastly there is surgery. Spine surgery should be considered very carefully as an option to treat spondylolisthesis. While surgical decompression of the nerve roots may seems the logical means to reverse the condition, the type, location and severity of the disc issue must be considered in any surgical decision.
Getting Legal Help
In personal injury cases, back injuries and their respective treatment are extremely common. Whether the case involves a car accident, slip and fall, or a work injury, the back is susceptible to injury. Injuries to the spine in these types of cases should be carefully handled by both the medical professionals and legal professionals involved. Just like the proper treatment will result in the best possible medical result, the proper handling of a back injury by a personal injury lawyer will result in the best possible legal result.
Back injuries, including spondylolisthesis, can sometimes result in long term disability or, in more severe cases, permanent disability. While how the accident happened and the diagnosis of the injury are important, the prognosis can be just as important in a personal injury claim. Prognosis is the forecast or the future expectation of the injury. The prognosis is important because if the back injury is expected to last for a long term or permanently than the damages sought must take this into consideration. For instance, not only are the lost wages a person incurred recoverable for the time he or she missed work due to the injury, the loss of anticipated future earnings must also be considered depending on the prognosis of the back injury. Also, reasonably anticipated medical procedures and bills must also be taken into consideration when handling a personal injury claim.
If you or someone you know has been involved in an accident and suffered a back injury, including spondylolisthesis, feel free to contact us or call (508) 879-3500. We offer free case evaluations and will explain how we can help you.