Introduction
MRIs of the spine are frequently performed after a new episode of back or neck pain, or at some point after trauma to determine the possible cause of pain, and to develop a possible treatment plan. When disc abnormalities are seen, such as bulges, herniations/protrusions, or fissures, one may ask whether these findings are the source of the pain. Another question may be whether a specific traumatic event caused these findings. Understanding how disc herniations develop and how they may relate to pain are questions that a Spine MRI Expert Witness may be called upon to answer.
Potential Causes
The first question to consider is how disc herniations and other disc abnormalities develop. Like other tissues in the body, spinal discs age over time and can lose their structural integrity. As a disc ages, it will dehydrate, and the outer ring of the disc, known as the annulus, can weaken. This process can lead to disc thinning, disc bulges, disc herniations, or fissures in the disc. This process can occur regardless of a history of trauma. The biggest risk factor for this process has been found to be heredity, with signs of disc degeneration developing in childhood. A Spine MRI Expert Witness may be able to offer an opinion as to whether the disc herniation developed as a result of trauma or through the aging process.
Often, individuals with back or neck pain only have an MRI that was performed after the pain began, which would seem to make a determination of causation challenging; however, research that has evaluated spine MRIs of people before and after new episodes of pain or trauma has shown that MRI findings rarely change after new episodes of pain or trauma.
Cadaver studies have shown that spinal discs are quite tough, and that the force required to cause a disc herniation will also fracture the surrounding vertebral bone. The combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology state that, “the term ‘herniated disc’ does not imply any knowledge of etiology, relation to symptoms, prognosis, or need for treatment,” and that, “from the standpoint of description of images, such discs, in the absence of significant imaging evidence of associated violent injury, should be classified as degeneration rather than trauma.” A Spine MRI Expert Witness may offer an opinion as to whether the disc herniation was or was not caused by a traumatic event.
Symptoms
Another question to consider is whether all spinal disc abnormalities cause pain. Multiple studies have demonstrated that a high proportion of individuals in the general population have disc herniations, disc bulges, and annular fissures in spinal discs without experiencing pain. These MRI findings by themselves do not indicate that they are a source of pain. A Spine MRI Expert Witness will also consider specific patient complaints and physical examination findings to determine if the MRI findings are the source of pain, or if they are just asymptomatic incidental findings. A Spine MRI Expert Witness will consider whether there is correlation between the findings on the MRI and the patient complaints and physical examination findings when evaluating spinal disc abnormalities.
Annular Tears or Fissures
Radiology reports sometimes include the term “annular tear” to describe what should appropriately be called an “annular fissure.” Annular fissures are another type of degenerative condition that occurs as the disc ages. This has been addressed by the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. They state, “As far back as the 1995 NASS document, authors have recommended that such lesions be termed ‘fissures’’ rather than ‘tears,’ primarily out of concern that the word ‘tear’ could be misconstrued as implying a traumatic etiology.” A Spine MRI expert witness may opine as to whether an annular fissure is present on an individual’s MRI and may also opine as to the causation of same.
Conclusion
The determination of the cause and meaning of various findings on MRIs of the spine can be challenging. A Spine MRI Expert Witness can assist with evaluating these findings and determining whether they are degenerative in nature or caused by a traumatic event.
About the Author
Robert J. Nocerini, MD is a triple-board certified pain medicine physician and the owner of Northstar Joint & Spine in Plano, TX. He treats chronic pain conditions including back and neck pain on a daily basis. He is an experienced expert witness and life care planner. Dr. Nocerini can be contacted at (925) 389-0790 or by email at robert.nocerini@gmail.com.
References
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