This case involves a young boy who was in a car accident when he was 7-years-old. The defendant rear-ended the plaintiff’s car in the parking lot of an elementary school. At the time, the plaintiff’s vehicle was stationary and the child had not yet put on his seatbelt. As a result of the impact, the child suffered serious injuries, including a fractured skull and chronic back pain. The child was put into rigorous physical therapy treatment for his back pain, but therapy did not improve his condition. At age 11, the boy received an MRI that revealed a herniated disc. It was alleged that the car accident directly caused the herniated disc in the child.
Question(s) For Expert Witness
- 1. Have you diagnosed and treated disc herniations in children? If so, how common are they?
- 2. What physical exam and imaging findings, if any, help determine when the herniation occurred?
- 3. What physical exam and imaging findings, if any, suggest a certain mechanism of injury?
Expert Witness Response E-123546
I have diagnosed and treated disc herniations in children multiple times. On physical exam for a herniated disc, leg pain or neurological symptoms would be a sign. That would make me suspicious of other injuries. A disc herniation is almost unheard of in a child under the age of 10. That would not be high on my differential diagnosis list unless there were other neurological signs, numbness, weakness, positive straight leg test. Back pain in itself is a non-specific problem. The history of past injury and what happened during the injury as well as the initial recovery would be important. In this specific case, back pain alone without neurological signs (numbness or weakness) is non-specific. A disc injury under age 10 very uncommon. Back pain in kids is very common. Herniation in children secondary to trauma in children under 10 is also extremely uncommon. It is more common to have a fracture of the bone or growth plate (limbus fracture). Evidence of herniation in adolescents is unlikely secondary to an injury early on. Adolescents have a higher rate of disc problems in comparison to children because they are more mature and the growth plates are closing. In younger children, the bone or growth plate will usually fail first with an injury.