Spinal Injuries After a Crash: Herniated Discs, Surgery, and What Your Case Is Worth

Published January 26, 2016 · Injury Law Basics

The crash was three weeks ago. Your neck or low back has not stopped hurting, and now there is a new symptom: a burning or electric pain that runs down one arm or one leg, sometimes with numbness in the fingers or toes. Your family doctor orders an MRI, and the report comes back with words you have to look up: "disc herniation," "foraminal narrowing," "nerve root impingement."

Spinal injuries are the most common serious injury we see from car, truck and motorcycle collisions in the Dayton area, and they are the injuries where insurance companies work hardest to pay as little as possible. This post explains what these diagnoses mean, how the claims are evaluated, and why the early decisions you make matter so much.

The anatomy, in plain English

Your spine is a stack of bones (vertebrae) separated by discs. Each disc is a cushion with a tough outer ring and a soft center. Nerves branch off the spinal cord and exit between the vertebrae to supply your arms, trunk and legs.

• A bulging disc flattens and spreads slightly beyond its normal edge.
• A herniated disc (also called ruptured or extruded) has a tear in the outer ring that lets the soft center push out.
• When the displaced disc material presses on a nerve root, the result is radiculopathy: pain, tingling, numbness or weakness along the path of that nerve. In the neck this shows up in the shoulder, arm and hand; in the low back it is the classic "sciatica" down the leg.

The force of a collision, especially a rear-end impact or a motorcycle rider's sudden deceleration, can tear a disc that was perfectly functional the day before. Symptoms often start within hours but can take days or weeks to fully develop as swelling sets in.

How these injuries are treated, and why the record of treatment matters

Most patients start conservatively: anti-inflammatories, physical therapy, and activity modification. If symptoms persist, the next step is usually a referral to a spine specialist or pain-management physician for epidural steroid injections. When injections fail and the imaging matches the symptoms, surgery is discussed: a discectomy to remove the herniated material, or a fusion to join two vertebrae with hardware and bone graft.

From the standpoint of your claim, every step of that progression is evidence. The therapy notes document how the pain limits you. The injection records show the injury did not respond to simpler care. The surgeon's operative report describes what was actually found inside your spine. Gaps in that record, such as a month between visits or a referral that was never scheduled, become the insurer's argument that you were not really hurt. I have written before about why seeing a doctor promptly after a crash is not optional, and spinal cases are where that advice carries the most weight.

The "degenerative" defense

Here is the argument you will hear in nearly every spinal case: the MRI shows "degenerative disc disease," so the herniation was already there and the crash did not cause it.

There is a kernel of truth in it. Most adults over 30 have some disc degeneration visible on imaging, often without any symptoms at all. Insurers use that fact to recast an acute injury as a pre-existing condition. Here is how we answer it:

• The symptom timeline. If you had no neck or back complaints before the crash and radiating pain afterward, the change in your condition is the injury, regardless of what the disc looked like beforehand.
• Prior medical records. We obtain your records from before the collision to show that you were working, exercising and living without treatment for your spine.
• The treating physician's opinion. Ohio law asks whether the crash was a proximate cause of your current condition. A surgeon who testifies that the collision aggravated a previously silent degenerative disc into a symptomatic, surgical one establishes exactly that.
• The eggshell-plaintiff rule. Ohio has long held that a wrongdoer takes the injured person as he finds her. A driver who herniates a disc that was already weakened is responsible for the full result, not a discounted version. I explained the rule in this post on pre-existing conditions.

What drives the value of a spinal case

Compensatory damages in Ohio fall into two categories, and the distinction is not academic.

Economic loss includes medical bills, future medical care and lost income. There is no statutory cap on economic damages. In a fusion case, the past bills alone often exceed $100,000, and a credible estimate of future care (hardware revision, adjacent-level disease, long-term pain management) can be substantial. Lost earning capacity is frequently the largest number of all: a 45-year-old tradesman who can no longer lift fifty pounds may have lost twenty years of income. I covered how we document that in Lost Wages and Lost Earning Capacity.

Noneconomic loss is pain, suffering, loss of enjoyment of life and similar harms. Under R.C. 2315.18(B)(2), noneconomic damages in most injury cases are capped at the greater of $250,000 or three times economic loss, up to $350,000 per plaintiff. But R.C. 2315.18(B)(3) removes the cap entirely for a "permanent and substantial physical deformity, loss of use of a limb, or loss of a bodily organ system," or a permanent injury that prevents you from independently caring for yourself. Whether a spinal fusion with permanent restrictions qualifies is a fact question that must be developed with the surgeon's testimony, and it can mean the difference between a capped and an uncapped verdict. This is one of the most important issues in any serious spinal case and one that an unrepresented claimant will never hear about from an adjuster.

Why quick offers hurt most in spinal cases

An adjuster who calls six weeks after the crash with a $15,000 offer is not being generous. The adjuster knows a disc injury is often undiagnosed at that point and that once you sign a release, the surgery you need eight months later is your problem. Spinal cases should not be valued until your doctors can say what your condition will be permanently, which usually means after conservative care has run its course and any surgical recommendation is on the table.

The other practical issue is coverage. A fusion case can exceed the at-fault driver's policy limits several times over, which makes your own underinsured motorist coverage, and the setoff math I discussed earlier this month, central to what you actually recover.

What this means for you

If an MRI after a crash shows a herniation and you have radiating symptoms, treat the claim as a serious one from the start. Follow through with every referral. Keep a simple daily note of pain levels and what you could not do. Do not give a recorded statement or sign a medical authorization for the other driver's insurer without advice. And do not accept any offer until your treating physicians have given a long-term prognosis.

Our personal injury practice, including car accident and motorcycle crash cases, handles spinal injuries from the first MRI through surgery and trial if necessary.