Degenerative Disc Disease and Auto Accidents

As you can imagine, when anyone with degenerative disc disease is involved in an auto collision, the potential for devastating injuries is significant. Unfortunately, there are few diseases worse than degenerative disc disease in terms of crash-related injuries. Not only can car accidents cause new injuries, but they can also exacerbate pre-existing medical conditions, leading to complications. Disk herniation is the most common disk-related injury sustained in these kinds of accidents.

Taking time off to allow the body to heal often results in lost wages. Diagnosis of spine injuries is usually delayed until less expensive tests and treatments are completed. That, combined with requiring multiple doctor appointments for referrals to specialists, means a person cannot be diagnosed for weeks to months. Although treating spine injuries conservatively before considering surgery is generally a good idea, this can result in surgery being delayed for months to years. Even though many surgeries are minimally invasive, they often require one to two weeks away from work and light duty for six to 12 weeks. There are co-pays, deductibles, etc.

To enable a collision victim to concentrate on healing and to find out how to access the best health care, it is best to consult an injury attorney who handles auto accidents extensively. Ideally, one who has represented people with pre-existing conditions.

To understand degenerative disc disease (DDD), it is necessary to first understand the anatomy of the human spine. Most people know that the spine is composed of many vertebrae which protect the spinal cord. Human vertebral columns usually contain 26 bones divided into five major regions. The neck is composed of seven cervical vertebrae, and the chest is composed of 12 thoracic vertebrae. The lower back is composed of five lumbar vertebrae. The sacrum, which forms the lower back and pelvis, is created by five vertebrae that fuse together during growth to adulthood. Last is the coccyx, or tailbone. Between the vertebrae of the spine are small cartilage pads called vertebral discs, which essentially act as rubbery shock absorbers in the spine. There are a total of 23 intervertebral discs in the human body. When healthy and functioning correctly, this shock absorption system of the spine cushions movement connects the vertebrae together and serves as a system of cartilaginous joints (joints formed of cartilage instead of bone) which allow movement in the spine. The spinal cord runs through a small canal in the vertebrae, with nerves and vertebral blood vessels feeding into it at virtually every level.

Degenerative disc disease occurs when the intervertebral discs begin to deteriorate to a less functional state, either through the natural course of aging, after an injury, or due to extenuating circumstances such as factors predisposing people to this disease. As the discs deteriorate, they lose volume, making them unable to perform their essential functions, absorbing shock from movement and impact, cushioning the vertebrae, and maintaining the space between them. This process and the body's response to it constitute degenerative disc disease.

One of the leading causes of degenerative disc disease is the aging process. The normal wear and tear of a lifetime of using one's spine combined with the fact that the materials composing discs tend to deteriorate with age, as well as the loss of strength in the ligaments which help maintain disc position, lead to weakened discs that can easily be torn or injured with even a slight movement. Discs also tend to thin and lose volume as we age, leading to less space between vertebrae. Incidentally, this is why human beings lose height as we age. Over time, the distance between vertebrae can collapse, causing them to rub against each other. Abnormal bone begins to grow at the ends of the vertebrae, forming bone spurs. These spurs can rub against each other and press against (or pinch) nerves and blood vessels, thus causing varying degrees of pain. Long-term arthritis develops in the spine, discs can become injured, and spinal stenosis (spinal canal narrowing) can occur. Eventually, this can become incapacitating.

Although age is a contributing factor, and most people who live long lives develop age-related degenerative disc disease, there are risk factors that make some young people more susceptible to the early onset of this illness.

There is evidence that degenerative disk disease is inherited. Although specific genes have yet to be identified, several studies have shown that degenerative disk disease often clusters in families, indicating both heredity and possibly an underlying genetic predisposition. Obesity is another significant risk factor. Unfortunately, carrying extra body weight puts additional stress on their skeleton, leading to accelerated joint degeneration (essentially aging faster). This is especially true in the spine, where excess weight compresses the vertebral discs, nearly squashing them into a flatter shape, which is much more susceptible to injury. Fortunately, weight-related disc issues are often relieved by losing weight, although the method must be gentle to the spine to avoid injuring already stressed discs. High-impact exercise is hazardous in this situation. Those significantly overweight and unaccustomed to physical activity would do best to visit a physical therapist to develop a safe fitness routine.

Because pregnancy essentially adds additional weight to a woman's body, particularly in areas where it must be supported by the spine, it also sets women up for extra wear and tears on their vertebral discs. In women who do not have a lot of core muscle strength, the spine literally bears all the additional weight, causing dangerous compression. This alone can often lead to disc injury (bulging or herniation). Unfortunately, the extra intense strain of labor and the added stress of contractions, particularly on the lumbar spine, creates another "perfect storm" scenario for disc injury. Unfortunately, these injuries are often entirely overlooked for months or years because the additional pain caused by the damage is often attributed (by mothers and physicians) as the result of birth, labor, and the physical strain of motherhood (carrying an infant everywhere causes back aches). For these reasons, it is best for pregnant women to talk wither their doctors and develop a safe exercise plan to strengthen their core muscles before labor and, if possible, before the last two trimesters of pregnancy when the baby's size is most taxing to the mother's back. Any pregnant woman who knows that she has degenerative disc disease has experienced a spine injury, or has any underlying conditions that make disk injury more likely, should work with a physical therapist to prepare her spine for the stressors of pregnancy and labor. It is crucial to find a physical therapist who has worked with pregnant women and people with underlying risk factors (especially if the patient has a spine injury or an auto-inflammatory disease). Women with serious lumbar spine issues may want to discuss birth by cesarian section with their doctor to avoid further spine damage. The more pregnancies a woman has, the more likely she is to sustain spinal injury. This is especially true of pregnancies involving more than one infant. Very often, women carrying multiple babies will need to undergo a period of bed rest.

Occupations requiring physical labor can also predispose people to degenerative disc disease, mainly if it involves bending and/or lifting repetitively and carrying heavy items. Many people who work in the construction industry develop degenerative disc disease or sustain disc injuries that set the condition in motion. Similarly, professional and extreme athletes, those who train for physically demanding events and activities, those who exercise excessively, and those with exercise addiction are also predisposed to this disease because the additional activity accelerates disc aging and deterioration.

Unfortunately, people with Ankylosing Spondylitis, Rheumatoid Arthritis, Psoriatic Arthritis, and other auto-immune or chronic inflammatory diseases are more likely to develop degenerative disk disease, often at younger ages, for a variety of reasons. This is another group of people who benefit from targeted physical therapy to gently strengthen the core muscle groups. Doing so can improve existing injuries and prevent future injuries. It is also essential that people in this group avoid overdoing physical exercise and labor as they are already predisposed to disc injury and disease. These patients should avoid repetitive bending and lifting. They must accept that they are differently abled and not push themselves into physical activities. The average physical trainer is not qualified to work with this group of people, and many have caused painful permanent injuries with their lack of knowledge. These patients should be very cautious about screening trainers, physical therapists, yoga instructors, etc., to ensure that they are experienced working with people with the unique physical issues these diseases cause. There are specific courses (available at many community colleges and vocational schools) that provide trainers wishing to work with patients with degenerative disc disease, ankylosing spondylitis, rheumatoid arthritis, spinal injury, etc. An exercise-induced injury that wouldn't be terribly significant to the average person can lead to chronic pain for people with degenerative disk disease, auto-immune and chronic inflammatory diseases. Screening medical and fitness professionals are well worth the time investment.

Disc injury is one of the most significant risk factors for developing degenerative disk disease. The disc is a series of cartilage layers, like an onion, with a gel-like nucleus at the center. The nucleus primarily comprises water and collagen and provides much shock absorption capacity. When discs are inflamed or under pressure, the layers of the disc can tear, allowing the softer nucleus to slide out (think of the jelly in a jelly donut when the donut is squashed). This is often called a bulging, herniated, or slipped disc. If the disc's outermost layer is torn open and larger quantities of the nucleus have leaked or been compressed outside of the disc, this is a ruptured disc. These injuries can change the shape and volume of the disk, leading to the deteriorative process called degenerative disc disease.

The resulting symptoms from even a mild bulging disc can be excruciating and downright debilitating. These injuries cause irritated, inflamed nerves, which become painful and can even cause numbness, tingling, and loss of function. Sometimes the pain comes and goes; in other cases, it is constant no matter the body's position. Having part or all of the nucleus in the wrong place inside the finite and inflexible confines of the intervertebral space leads to immense pressure on the nerves themselves. In more severe injuries, the disc, or shards of it, can pinch nerves and impinge vertebral arteries (limiting blood flow into spine areas). These injuries often require some form of surgical intervention to restore function and decrease agonizing pain.

It is important to note that repeated injuries to the same area of the spine can cause a bulging disc to worsen. Anyone with a mild or moderately bulging disc can become a fully ruptured disc if it is reinjured. Therefore, car accidents for people who already have bulging discs can be devastating. They can go from having a slight protrusion of the nucleus, which is manageable with physical therapy and lifestyle modifications, to a prominent bulge if the tears in the rings are worsened by the jarring physical impact and excessive physical force of a collision. In fact, these are precisely the kind of complex injuries that often require surgery. Even a minor fender bender can seriously damage the disc of a person with degenerative disc disease, significantly if the disc was previously injured.

Symptoms of degenerative disc disease include pain, especially in the back and neck. The location where the disease is most active and the severity of the deterioration determine the specific area of symptoms and the level of discomfort. The initial stages of this disease may not involve severe pain. Lumbar disease activation can cause pain down the legs, as the lumbar spine is where the nerves associated with the lower extremities enter the spinal column. Similarly, degeneration in the cervical spine can cause radiating shoulder and arm pain. The pain might be constant or come and go. Sometimes it is accompanied by numbness and tingling. Typically pain will increase when performing actions that utilize the spine, such as twisting, bending, etc. The pain may be exacerbated by sitting or standing but improve with walking. Weight-bearing activities (such as carrying a backpack or a small child) can be especially painful. Once the disease is impinging nerves, finding a comfortable physical position becomes extraordinarily difficult.

Although the more advanced stages of degenerative disc disease (such as bone changes) are visible on x-rays, this disease is most often diagnosed using an MRI, which provides a view of soft tissues (such as discs). Disc injuries are constantly diagnosed with an MRI, and anyone who suspects their pain is caused by a disc injury should request an MRI.

MRIs are a reasonably expensive test to perform and often require prior authorization from insurance companies. Doctors often send patients for x-rays and physical therapy before ordering an MRI. It usually requires persistence on the part of the patient to get a doctor to order this test. However, if the pain continues, it is in the patient's best interest to advocate for this test, especially before pursuing chiropractic treatment. If a person has inflamed discs that can be injured by any slight movement of the spine, it sets them up for injuries during chiropractic adjustments. The inflammation must be reduced to make spinal manipulation safe. Chiropractors cannot diagnose bulging or inflamed discs from x-rays. For this reason, patients are often told to rest and take anti-inflammatory medications at the beginning of treatment. Chiropractic care should be avoided until the second phase of treatment.

Initial symptoms of this disease and those caused by disc injuries are treated conservatively to give the body time to heal what it can. Rest and anti-inflammatory medications are often the first lines of defense, and sometimes, this is enough to relieve many symptoms. Doctors used to treat this illness with opioid painkillers, but these consequential, dangerous medications are now limited to the most severe cases. Many patients report CBD and cannabis products to help treat their pain, though traditional medicine has been very cautious about its use.

After a period of rest and attempts to reduce inflammation, physical therapy is the next course of action. Physical therapy aims to ensure that the body is functioning as well as possible, often through strengthening specific muscle groups. Patients may need to re-learn how to perform particular movements to utilize muscles instead of bones and joints. Often Degenerative disc disease is associated with core muscle group weakness, and strengthening this group can relieve symptoms by taking stress off joints. Physical therapy generally involves stretching and body weight exercises that may progress to resistance band exercises. Physical therapy is the absolute best place to start for those with any form of spinal injury or disease wishing to begin a fitness journey. These exercises and movements begin gently and are tailored to each patient to strengthen their muscles without causing damage. This does not, unfortunately, mean that physical therapy will be pain-free but ensures that a trained medical professional (NOT a physical trainer) supervises the process to ensure that the patient is safe and will not incur further injury.

Often treatment of this disease includes lifestyle changes. This may include examining an individual's weight, diet, exercise behaviors, and work duties. Carrying excess weight causes the spine to degenerate faster. For this reason, doctors recommend shedding any extra pounds. When one is limited in the exercises they can perform, diet is even more critical to weight management. Fad dieting can deny your essential body nutrients, making spinal degeneration worse. Instead of taking diet tips from social media, the news, friends and family, people at the gym, or anyone else who is an amateur, a patient should book an appointment with a medically certified dietitian.

Many people make the mistake of visiting nutritionists. However, nutritionists are not required to be licensed in the United States. When one has a severe medical condition, they should only take advice from licensed medical professionals regarding their health. Anyone can have an opinion, but only certified medical professionals should give medical advice. A patient's general practitioner can refer them to a dietitian. Who can examine their diet to maximize healthy weight loss and ensure that the patient consumes vital nutrients necessary to support spinal health? This will often result in changing one's diet and even beginning certain supplements. Although changing one's eating habits and going to physical therapy to start a fitness routine is not necessarily easy, most people agree that they would instead take these relatively non-invasive measures than have spine surgery. Fortunately, sometimes diet and exercise are enough to relieve the symptoms of this disease to such an extent that surgery is either not required or can be postponed for an extended period.

It is important to note that becoming underweight can result in muscle loss, exacerbating this disease by providing less support for the spine. This is why a healthy weight should be the patient's goal, as established by a physician. It is not only excess pounds then can be harmful to one's health. As stated, exercise addiction often sets people up for degenerative disc disease. Unfortunately, eating disorders deny the critical body vitamins, minerals, and nutrition and can set a person up for everything from early-onset osteoporosis to heart disease. Any patient who struggles with eating a healthy diet due to pursuing a specific body type must recognize that this will have long-term consequences for their health, including their spine, and also consider visiting a dietitian.

Degenerative disc disease permanently changes the spine, and the patient must accept that their neck and back will never be the same as before this disease developed. Unfortunately, some things will no longer be possible for many patients. High-impact exercise, such as running, jumping rope, or physical contact sports, will need to be discontinued by most patients at some point. Excessive exercise may need to be reduced, but continuing healthy exercise and movement is essential.

Those with particularly physical jobs may need to consider reducing repetitive bending, lifting, or twisting at work. If a person stands or sits all day, their workstation may need to be modified to enable them to alternate between sitting and standing. Unfortunately, this can mean obtaining an assessment from a doctor detailing what the patient is no longer physically able to do and any recommended accommodations and taking this to one's employer to request a reasonable accommodation. Although employers may not want to comply, affordable accommodation is a legal right for anyone who works in the United States. There are legal avenues to pursue if an employer gives the patient pushback. To document any kind of employer resistance, it is in the individual's best interest to conduct all of this via writing. Any in-person meetings should involve not just the employer and the employee but, if possible, a union representative and a human resources representative. Unfortunately, despite laws preventing discrimination, many employers discriminate against people who cannot perform the same job they once were. In these situations, the patient may have to advocate for themselves. It is never a bad idea to obtain legal advice in these situations.

When lifestyle changes and medications aren't enough to sufficiently relieve symptoms, several other treatment options exist. Epidural steroid injections involve injecting steroids directly into the area of the spine affected. This can reduce inflammation and improve function for many people and is a minimally invasive procedure that can be repeated. If the disease involves disc herniation, several surgical options are available. Although many people are terrified at the prospect of spine surgery, many patients who undergo it (including this author) receive tremendous relief from the moment they awake after surgery.

Additionally, many of these surgeries are far less invasive than people assume and do not require a lengthy hospital stay, work absence, or extended downtime and recovery period. Although surgery cannot return one's spine to a perfect condition, in many cases, it can provide such extraordinary relief that patients feel they have been given their lives back. Although not everyone will be a good candidate for surgery, discussing the option is worth a patient's time. Several surgical options are available, including laser spine surgery, so seeing more than one surgeon before deciding a course of action is always in a patient's best interests.

Additionally, not all surgeons are created equally, and there are thousands to choose from. Before any surgery, a patient should extensively research their surgeon. This includes verifying their certifications and credentials and ensuring they have not received a reprimand from professional organizations such as the Medical Review Board. 

Patient reviews are also important factors when choosing a surgeon. These are based on actual patient experiences, and although many critics (doctors) say that these reviews are based on opinions rather than facts, patients do not need a medical degree to be able to evaluate whether their own pain levels have decreased, the function has improved and if bedside manner and professionalism of their doctor meets their personal standards. Patients should not base decisions on one review but should try to read as many as possible. Healthgrades.com is an excellent place to read about physicians and share your experiences.

It is important to note that some healthcare organizations, Kaiser Permanente, pay for services to remove online reviews of their physicians from non-Kaiser sites. Since they control their own websites, it is safe to assume they can remove unfavorable reviews from them. Because of this, it can be tough to get a clear picture of patient experiences. One way to circumvent this process is to utilize social media. Apps like NextDoor and local FaceBook groups can be good places to ask your neighbors for physician and surgeon recommendations. If a patient has confirmed that they need surgery but is stuck with a healthcare system that doesn't allow reviews to remain online, it is better to change health plans than to have a surgeon whose career performance is not available for review. Good surgeons have nothing to hide.

Additionally, there is no other service in which a person is pressured to hire someone whom their insurance will pay tens of thousands of dollars without proof of acceptable performance in the insight of customer reviews. If an auto-repair company attempted this, it would lose business. Since one's spine is significantly more precious than an automobile, it makes no sense to fund a surgeon or health care system, limiting patients' ability to share their experiences.

Watch the YouTube video below to follow Beth's struggle with degenerative disc disease before undergoing surgery for an artificial disc replacement.

I'm Ed Smith, a Northern California Personal Injury Lawyer. If you or a loved one has been injured in an accident and have developed a worsening degenerative disc disease, please call our law firm at (916) 921-6400 or (800) 404-5400 for free, friendly case advice.

Image by Gundula Vogel from Pixabay

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