This case involves two passengers who were involved in a car accident on their way to the airport. The accident took place in February following an ice storm. There were icy conditions on the highway which caused a charter bus to spin out of control and hit the car in question. The car spun off the highway and into a ditch, subjecting the passengers to turbulence motions. After the event, the passengers suffered from spinal injuries including bulging discs of the back. An orthopedist with specialization in spinal injury was sought to conduct an independent medical examination to identify the clinical status of the passengers and ascertain correlations of the alleged injuries with the mechanism of the accident.
Question(s) For Expert Witness
- 1. Do you routinely manage patients with chronic and acute presentations of back injury?
- 2. Are you able to assess radiographs and data pertaining to such patients clinical status?
- 3. How would you draw conclusions regarding such injuries, and whether they predate or postdate an accident?
Expert Witness Response E-075923
The identification of degenerative disc disease at one or multiple levels, similar to the finding of arthrosis in an extremity joint, is not diagnostic of injury or disease-related pathology because such degenerative changes can be a natural consequence of the aging process. The definitions and requirements for a radiculopathy are from the AMA guidelines for the evaluation of permanent impairment. Radiculopathy is defined as significant alteration in the function of a single or multiple nerve roots. The diagnosis requires clinical findings including specific dermatomal distribution of pain, numbness, and/or paresthesias. Subjective reports of sensory changes are more difficult to assess. Therefore, these complaints should be consistent and supported by other findings of radiculopathy. There may be some associated motor weakness and loss of reflex. A root tension sign is usually positive. The identification of a condition that may be associated with a radiculopathy (such as a herniated disk) on an imaging study is not sufficient to make a diagnosis of radiculopathy. Clinical findings must correlate with the radiographic findings in order to be considered. There is insufficient scientific evidence to attribute the cause of lumbar disc herniation to any minor trauma event or ergonomic risk factor. The cases in which there is just a temporal association between an event and the onset of sciatica from a disc herniation logically represent when the herniation occurs, but not why it occurs.