Anatomy of the neck, spine, back and spinal cord.
In possibly the first historical mention of the spine and the spinal cord, Herophilus (325–260 BC), a Hippocratic physician working in the Alexandrian School of Medicine demonstrated that the cord was an extension of the hind brain and named it the ‘spinal cord’. Around 160 AD, while working as a physician for the Roman emperor Marcus Aurelius, Galen completed dissections and vivisection's that enabled the anatomical details of the vertebral column, spinal cord and nerve roots to be recorded. Galen described the cord as being like “a river rising from its source, extended from the brain, continuously sending forth a nerve channel to each of the parts that it meets, through which both sensation and motion are conveyed”.
Much has been learnt since those early studies and significant research expenditure continues to be focussed on further understanding the neck, back, spine and spinal cord. The spine is a complex construction that provides protection for the spinal cord and nerves and gives our bodies structural support. Without the spine approximately half of our body weight would not be supported and we would not be able to stand upright or walk. On average we are born with 33 vertebrae which connect to each other through flexible facet joints. By adulthood, most of us only have 24 vertebrae as vertebrae at the bottom of the spine fuse together during our development.
The American Association of Neurological Surgeons note that the spine comprises of four sections being the:
- Cervical vertebrae (C1-C7): located in the neck;
- Thoracic vertebrae (T1-T12): located in the upper back and attached to the rib-cage;
- Lumbar vertebrae (L1-L5): located in the lower back; and
- Sacral vertebrae (S1-S5): located in the pelvis.
The back comprises of the spine, the spinal cord, spinal nerves and several different muscle groups.
The spinal cord is a bundle of nerves that travel from the brain to the limbs and internal organs. It carries vital sensory information from the body and some from the head to the central nervous system and performs much of the initial processing of this information. Motor neurons in the spinal cord help to control muscles that mediate voluntary and involuntary reflexes and regulate the autonomic nervous system which manages involuntary bodily functions like heartbeat and breathing.
The neck, spine, back and the spinal cord are of great medical importance as they are sites of potential traumatic injury and the starting point of many diseases.
Neck, spine, back and spinal cord injuries – what are they and how do they occur?
Neck, spine and back injuries compared with spinal cord injuries involve very different symptoms, treatment and health outcomes. It therefore makes sense to discuss them independently herein.
Neck, Spine and Back Injury
Neck, spine and back injuries are common and can be caused by trivial and seemingly innocuous events like bending over to pick up a dropped item or twisting to take something off a shelf. A number of key risk factors have been proven to increase the likelihood of a neck, spine or back injury and include fitness level, weight gain, age, genetics, mental health and smoking.
As specialist, Western Australian personal injury lawyers we see many clients that have suffered neck, spine or back complaints due to work accidents, motor vehicle crashes and accidents in public or private places. Many jobs involve repetitive heavy lifting, pushing and pulling and these tasks are a very common cause of workplace neck, spine and back injuries. Similarly, jobs that involve the back twisting, turning, vibrating or being positioned in awkward or confined spaces frequently cause workplace injury. Motor vehicle accidents are a very significant cause of neck, spine and back injuries. Car accidents that involve rear end or head on collisions commonly result in the victim being subjected to whiplash motion and its associated trauma. This trauma often causes wide ranging neck, spine and back injuries.
Whiplash injuries to the cervical spine or neck are one of the most common injuries suffered in car accidents. These injuries usually consist of soft tissue trauma which does not necessarily impact on the spinal cord, vertebrae or nerve roots. Unfortunately, if the road accident victim suffers from an underlying degenerative condition in the cervical spine which was symptomatic prior to or at the time of the accident, we often see that the overall injury and symptoms become more problematic and require significantly more pain management and treatment. In these cases, the soft tissue injury caused by the whiplash aggravates the degenerative condition and typically causes most symptoms to become more severe.
Another scenario involves car crash claims where the victim has a degenerative spinal condition from before the time of the accident but that it has remained largely asymptomatic. In other words, if you had x-rayed the client’s back just prior to the car accident it would have shown a degenerative process occurring in the spine, however, the client may have been asymptomatic. This is quite a common scenario where a relatively minor whiplash injury to the neck can go on to trigger a serious asymptomatic degenerative spinal condition. Please follow this link to find additional information on the diagnoses and treatment of whiplash injuries in our blog post on the matter.
Broadly, injuries to the neck, spine or back can range significantly in intensity. At one end of the spectrum a dull, constant ache could be experienced whereas at the other extreme excruciating, sharp and shooting pain can be felt. Generally, there are two types of back pain diagnosed. Acute or short term back pain tends to resolve within a few weeks, requires minimal medical intervention and does not cause any loss of function. In contrast, chronic back pain is experienced for 12 weeks or longer and symptoms can persist after medical and / or surgical treatment.
Acute and chronic injuries to the neck, back or spine usually involve an interruption to the mechanical structure of the back. The key mechanical components of the back include the vertebrae, intervertebral discs, facet joints, ligaments and nerves which fit and move together. The British Institute of Neurological Disorders and Stroke provides a very helpful list of how the mechanics of the back can be disrupted:
- Sprains (overstretched or torn ligaments), strains (tears in tendons or muscle), and spasms (sudden contraction of a muscle or group of muscles).
- Traumatic injury that can injure tendons, ligaments or muscle as well as impact the spine and cause vertebrae to rupture or herniate.
- Intervertebral disc degeneration which occurs when the usually rubbery discs wear down and lose their cushioning ability.
- Spondylosis being the general degeneration of the spine associated with wear and tear that occurs in the joints, discs and bones of the spine.
- Inflammatory disease like spondylitis which involves the inflammation of a vertebrae.
Nerve and Spine Injuries
- Spinal nerve compression, inflammation and / or injury.
- Sciatica or radiculopathy which is a pressing on the sciatic nerve which causes pain to travel through the buttocks and extend down the back of the leg.
- Spinal stenosis or the narrowing of the spinal column which puts pressure on the spinal cord and surrounding nerves.
- Spondylolisthesis where a vertebra of the lower spine slips out of place and pinches the nerves exiting the spinal column.
- Herniated or ruptured discs that occur when the intervertebral discs become compressed and bulge outward.
- Infections involving the vertebrae, intervertebral discs or the sacroiliac joints.
- Cauda equina syndrome which involves a ruptured disc pushing into the spinal canal and impacting the bundle of lumbar and sacral nerve roots.
Spinal Cord Injury
While spinal cord injuries can occur due to medical conditions like spina bifida many of these injuries are caused by the patient being involved in a very violent and traumatic accident. It is common for expert personal injury lawyers to see spinal cord injuries that have occurred due to serious work accidents, catastrophic car smashes and very significant slip, trip or fall type accidents. In these types of accidents compression, trauma or bruising to the spinal cord causes a loss of physical function, mobility or feeling. Contrary to some misconceptions, the spinal cord does not need to be severed for very serious injury to be sustained. Spinal Cord Injuries Australia is a non-government organisation which supports people with spinal cord injuries and explains that these injuries are either complete or incomplete. A complete spinal cord injury involves no signals passing between the brain and body below the point of injury. This means that the injured person experiences no sensation or voluntary movement below the point of injury. In an incomplete spinal cord injury the patient may be able to move a limb more than another limb, feel parts of the body that they are not able to move or may have more physical function over one side of the body compared to the other side.
Spinal cord injuries that occur below the T1 vertebrae result in paraplegia or a loss of function below the chest. Here, Spinal Cord Injuries Australia, provides helpful detail noting that injuries between the T1 vertebrae and the T8 vertebrae result in the patient usually having control of their hands but no abdominal muscle control which leaves poor trunk and core control. Injuries that occur lower down the spinal cord, like around the lumbar or sacral vertebrae, tend to result in a loss of control of the hip flexors and legs.
Where an injury occurs high up the spinal cord, like around the C1 or C2 vertebrae, the patient may suffer quadriplegia (also known as tetraplegia) and lose function from below the neck. In these extreme cases many involuntary functions like ability to breathe are compromised and a mechanical ventilator may be required. Again, Spinal Cord Injuries Australia provide a useful guide to the extent of these injuries and note:
- An injury at the C5 vertebrae often leaves shoulder and bicep control but, no control at the wrist or hand;
- An injury at the C6 vertebrae often leaves control of the wrist, but not of the hand; and
- Injuries at either the C7 or T1 vertebrae often leave the ability to straighten the arms but give only limited hand and finger dexterity.
In many cases spinal cord injuries also involve a range of very serious complications including problems with respiratory function, bowel control, bladder control, circulatory control, skin sensation, chronic pain, sexual health, depression and mental health issues.
Neck, spine, back and spinal cord injuries can have an extremely devastating impact on one’s ability to work, be active and enjoy life. If you have suffered this type of injury at work, in a road accident or in a slip, trip or fall it is extremely important to ensure that you get legal advice from an expert Western Australian personal injury lawyer.
Relatively minor car crashes can cause significant whiplash injury to the spinal cord where it is common to see disc protrusion at one or more levels of the spinal cord. These protrusions can go on to impinge on nerve roots and result in shooting pain, pins and needles, loss of sensation and / or strength down either one or both arms, all the way to the fingers.
Neck spine, back and spinal cord injuries – how are they treated?
Treatment for acute and chronic neck, spine and back injuries vary greatly. Usually a combination of rest, medication and physical therapy will be prescribed. In more serious cases surgical intervention may be recommended.
Medicines that can be prescribed include over the counter pain relievers, topical pain relievers, anti-inflammatories, muscle relaxants, opioids and antidepressants.
Physical therapy can involve physiotherapy, chiropractic, hydrotherapy and massage.
Surgical procedures can involve surgery, cortisone injections, radio-frequency neurotomy and implanted nerve stimulators.
Unfortunately there are currently no treatments or cures for spinal cord injuries. Many body parts and organs can, to some extent, repair themselves after a traumatic event. The central nervous system, of which the spinal cord is a part, unfortunately cannot repair itself.
Compensation claims for neck, spine, back and spinal cord injuries.
If you suffer a neck, spine, back or spinal cord injury at work it is important to understand that you can make a workers’ compensation claim if you:
- work full-time, part-time or casually;
- work seasonally or on commission;
- are an overseas worker;
- work for a wage or a salary;
- are over the age of 65;
- are employed in Western Australia but your work related incident occurred interstate or overseas; or
- if you resigned from, were terminated or made redundant by the enterprise where you suffered your injury or illness.
The West Australian workers’ compensation system is based on a ‘no-fault’ principle. This means that if you were at fault and caused your work accident you are still entitled to claim for workers’ compensation.
If you have suffered a very serious neck, spine, back or spinal cord injury in a work accident you may be able to make a common law or industrial negligence claim. These compensation claims can be made against an employer or any number of third parties involved in the accident. A common law claim is made on top of a workers' compensation' claim. In some common law claims there is no limit on the amount of damages that can be fought for so these claims can result in very significant lump sum compensation payments. To make a common law claim you must have a certain level of psychological and / or physical impairment and be able to prove that negligence caused your work injury.
If you were a driver, passenger, pedestrian or cyclist and a suffer a neck, back or spine injury you may be able to make a motor vehicle accident compensation claim. Here, it is vital to understand that you may be able to make a compensation claim even if you:
- contributed to the accident;
- did not follow road rules;
- were under the influence of drugs or alcohol;
- were not wearing a seatbelt;
- were not wearing a helmet while riding a motorbike, scooter or bicycle; or
- were riding unrestrained in an open-top vehicle.
If you have suffered a catastrophic spinal cord injury in a road accident you may be able to make a compensation claim through the West Australian Catastrophic Injuries Support Scheme. The Catastrophic Injuries Support Scheme is administered by the Insurance Commission of Western Australia. The Scheme provides treatment, care and support for people who have been catastrophically injured in a road accident and are unable to prove negligence against a driver or owner of a vehicle.
Accidents in Private or Public Places
If you suffer a neck, spine, back or spinal cord injury in a public or private place you may be able to make a compensation claim against the insurance policy held by the proprietor or owner of the property or premises. Here, it must be found that an owner or proprietor did not provide a duty of care and was negligent in not providing a safe environment. In turn the negligence must be found to have caused your accident.
Please note that each of these types of compensation claims involve very different and complex legislation and legal processes. Each of these pieces of legislation are particular to Western Australia so it is vital that you get legal advice from an expert injury lawyer that is based in Western Australia.
Neck, spine, back and spinal cord injuries - recent legal decisions.
The case of Hooker v Allied Pumps Pty Ltd [No 2]  WADC 129 highlights how a seemingly innocuous workplace accident can result in a debilitating spine injury and a very significant industrial negligence common law claim. Mr Hooker was working as a computer draftsman when a faulty gas detector alarm was triggered. The alarm startled Mr Hooker who turned sharply to identify the source of the noise. As he did so he hit his knees on the side of his desk and immediately felt pain to his neck and left and right shoulder. Mr Hooker was later diagnosed with various disc bulges and associated nerve impingement. The plaintiff underwent surgical treatment but continued to suffer from significant pain in his cervical, thoracic and lumbar spine and in his shoulders and limbs and could not return to work. Mr Hooker also developed acute anxiety and depression as a result of the accident. Judge McCann DJC found that the defendant breached its duty of care to the plaintiff and was liable for the injuries caused.
Judge McCann DJC found that Mr Hooker would not enjoy life to the fullest as he did before the accident and awarded the following damages:
- Past loss of earnings including superannuation contributions and loss of net investment returns on past superannuation - $530,643.98
- Interest on past loss of earnings and superannuation - $65,873.44
- Future loss of earnings including future loss of superannuation and future loss of net investment returns on superannuation - $564,514.20
- Past medical expenses - $262,440.43
- Past and future travel expenses - $5,000.00
- Future medical expenses - $95,048.12
- Past gratuitous services - $139,881.28
- Interest on past gratuitous services - $24,842.91
- Future gratuitous services - $153,120.04
- General Damages - $135,000.00
- Total - $1,976,364.40
Separovic Injury Lawyers – how can we help you?
Separovic Injury Lawyers have extensive experience assisting clients with very serious spinal cord injuries like paraplegia and quadriplegia (tetraplegia). These are often complex legal cases involving horrific accidents and it is crucial that your plaintiff injury lawyer secures all relevant evidence, expertly prepares the case and skilfully negotiates the best possible result with the insurer. Separovic Injury Lawyers also understand how painful, upsetting and debilitating a relatively mild neck, spine or back injury can be. Regardless of the severity of your injury, it is of critical importance that you obtain clear and down to earth information on exactly how much your compensation claim may be worth. Neck, spine, back and spinal cord injuries often involve complex diagnosis and lengthy treatment, and you need an expert personal injury lawyer to tell you exactly what treatment may be available to you, how long the claim process may take and how the best settlement outcome can be secured. Please do not delay and call us now on 9227 1000 for free, friendly and no-nonsense legal advice.