degeneration or accident related?

HI

I have been suffering low back pain since an RTA.  I experience sharp pain/shooting pain, burning sensations and tight back muscles amongst other aches and pains. I am managing my pain with painkillers but have been for 18 months now and have not noticed any improvement.  I have also had physio, seen a chiropractor?(back specialist) and since been referred back to physio.
I have recently undergone an MRI scan.  Results as follows

L2/3 Posterior annular tear and broad based dsc bulge with mild facet joint degeneration causing mild to moderate canal stenosis.  No lateral recess stenosis.

L3/4 Broad based disc bulge and facet joint degeneration noted.  No nerve root or thecal sac compression.

L4/5 There is a large broad based disc bulge and a focal disc bulge with facet joint degeneration causing moderate to severe canal stenosis.  the lateral recess has not been adequately evaluated, but I suspect there is at least moderate lateral recess stenosis bilaterally, worse on the left, compromising the left L5 nerve root.

L5/S1 Broad based disc bulge noted.  No nerve root or thecal sac compression.

My question is this.  Before the traffic accident I experienced no problem with back pain atall.  Are my symptoms accident related or symptoms of a degenerative condition?   And why do I feel it now and not before?

Many thanks

[kittyluv1]

While the accident may have exacerbated your current symptoms, it is most likely that degenerative changes were present previously.
It is probable that the accident was of such force to produce exacerbation of the symptoms to a more clinical level, but the findings on your MRI indicate your lumbar spine has primarily facet joint degenerative changes which have created stenosis (narrowing) of your spinal canal.
These type of changes usually progress over a period of time and are a normal process of the wear and tear on our spine as we age. The facet joints are like hinges at the back of the spine and assist in movement.  In the degenerative process the joints lose the lubricating fluid and cartilage that is needed for flexibility.  In addition, the intervertebral discs become drier and lose water content, making them brittle and tears or breaks in the annular covering of the disc can allow bulges of disc material to protrude and could potentially cause some nerve root compromise secondary to increased inflammatory reactions or stenosis (narrowing) of the central canal.
The surrounding and adjacent muscles contribute to the pain secondary to any strain or increased inflammatory condition.
If your current treatment program of physiotherapy and medication has not been effective over the period of 18 months, more effective treatment directed to the facet joints may be indicated.  A referral to an orthopedic spine specialist may be beneficial in obtaining more effective treatment.
Best wishes ----

[backpainz]

Thanks for your respnse.  

I understand your explanation.  I am aware of the symptoms.  It is the cause I am having a problem with.

Being an traffic accident, of course, solicitors are involved.  What you have outlined seems to be their defence.  That is, that I had pre existing changes which I would have suffered with anyway.

From my perspective I see it that I have been injured and my degeneration should not be held responsible for my ongoing symptoms.

I am off to see a specialist consultant soon.  Hopefully he/she may be able to see my perspective.  Fit and healthy one minute...pain in the axx the next (literally), shooting leg pains, back spasms, constant medication, unable to pursue career(constuction), lack of sleep, flash headaches and most worrying is possible surgery.  Please let them have some sympathy....something not many gp's or solicitors seem to have :(..  just fancy words and excuses.

YES i am fed up completely...bah!!

Is there anything I should put to the consultant to make him/her understand my position?  I feel injured AND partly to blame but I was rear ended!!

Thanks again

[kittyluv1]

I completely understand your concerns --- I am a post anterior cervical fusion patient and was unfortunately rear ended in the early stages of my recovery.  I was most concerned if any damage had been done to the fusion/hardware and what might be a major complication to my postop recovery.
Thankfully, x-rays showed no structural problem and although I had some neck and shoulder pains, physiotherapy helped and I suffered no long term ill effects.  I did however make certain that my automobile insurance carrier was informed and opened a medical claim for any possible injury --- the other driver's insurance being responsible for any medical costs.
I am assuming you have also taken this precaution and everything regarding the accident has been documented and verified by both parties.
The consultant may be able to determine if there is any apportionment related to the accident -- even though degenerative changes existed prior to the accident you were symptom free and able to perform usual and customary activity without difficulty.  Now  you are exhibiting signs of injury and your ability to perform job duties is at risk.  He might indicate what percentage of the injury is a probable result of the accident, but may not be able to state the accident was 100% at fault.  Either way, any medical costs up to and including surgery would need to be addressed by both parties.
The biggest issue is whether you were receiving medical treatment prior to your injury and if the potential for surgery had been identified in medical documentation.
Liability issues when insurance companies are involved become adverserial over minor disagreements such as this.  It might be beneficial to consult with a personal injury attorney as referred to you by your insurance carrier.
I wish you the best of luck and hope that you do receive the best medical treatment in order to resume your normal activity with no residual problems.

Keep us posted on your progress ----

[backpainz]

thanks again kittyluv

I sympathise with you because of your health issues.  I appreciate the concern/anxiety this would have caused  Good to hear you made a recovery, albeit through surgery.

In regard to my solicitor.  I find them very unhelpful.  Quick to instruct but not to advise.  I have  and am still trying to get my point across.  I was pain freee with no prior back issues.  Yes I accept there was degeneration present but, for a number of reasons, I do not accept this as my fate i.e apparently I would have shown these symptoms at some point in my life therefore the accident cannot be responsible for my ongoing symptoms...Hello!!! I am not stupid here!! and I am not a claim monger either. Although I have been in RTA before, this is the first time that I am claiming injury.

Now, my GP and the medico legal consultant have made comments to me that suggest I have suffered a chronic injury yet, on paper, They fail to support these claims (of which I have raised issues) and therfore I feel like I am losing the battle due to the lack of support.

My feeling is that i am being made a scapegoat of an industry tactic that prevents minor fender benders from going to court.

I think I would like a judge to make an unbiased decision based on the evidence BUT iI do need the specialist consultant to comment in my favour otherwise I probably have no case...Makes me anxious and stressed thinking about this.

Maybe I should accept the pittance that has been offered with my tail between my legs and scamper off with no regard or concern for the future health of my back... I think not.

Once again thankyou.  Will keep you posted.  And my sympathy goes out to anyone in a similar situation.

Much love