Back Surgery After a Serious Accident

A sudden accident can profoundly impact one’s life, particularly when it results in a severe back injury. Be it a bicycle mishap, a pedestrian collision, an automobile crash, or a motorcycle incident, these accidents can leave individuals grappling with excruciating pain and limited mobility. In such cases, back surgery often becomes a crucial treatment option to alleviate discomfort and restore functionality. However, the road to recovery does not end with the surgical procedure. Individuals who undergo back surgery after a serious accident are faced with lifelong changes, both physically and mentally. This article delves into the multifaceted aspects of back surgery following accidents, exploring the challenges, the potential outcomes, and the journey towards reclaiming a fulfilling life.

Spine Anatomy – a Quick Review

The spine, an intricate structure, is composed of distinct sections and various components that collectively support its vital functions.

It consists of 33 individual bones called vertebrae, divided into five sections: cervical, thoracic, lumbar, sacral, and coccygeal. Beginning at the base of the skull, the cervical section contains seven vertebrae, followed by the thoracic section with twelve vertebrae, and the lumbar section with five vertebrae. The sacral section comprises five fused vertebrae, forming the sacrum, while the coccygeal section consists of three to five fused vertebrae, creating the coccyx or tailbone.

Intervertebral discs, crucial components of the spine, play a vital role in providing flexibility, shock absorption, and cushioning between the spinal bones. These discs are positioned between adjacent vertebral bones and consist of two main components: the annulus fibrosus and the nucleus pulposus. The annulus fibrosus is the outer, fibrous ring encircling the disc, composed of layers of collagen fibers arranged in a crisscross pattern. It provides strength and stability to the disc. Within the annulus fibrosus lies the nucleus pulposus, a gel-like substance with a high water content. The nucleus pulposus functions as a shock absorber, distributing external forces exerted on the spine during activities such as walking, running, or lifting. The intervertebral discs not only facilitate movement and flexibility of the spine but also maintain space between the vertebrae, allowing for the passage of nerves and blood vessels. Over time, these discs can experience wear and tear, leading to conditions such as disc degeneration, bulging discs, or herniated discs, which may cause pain and discomfort. Understanding the anatomy and function of intervertebral discs helps to appreciate their crucial role in supporting the spine’s structural integrity and facilitating its range of motion.

Within the vertebral column lies the spinal canal, a hollow passageway formed by the vertebrae that encloses and protects the delicate spinal cord. The spinal cord is a long, cylindrical bundle of nerve fibers extending from the brainstem to the lumbar region, responsible for transmitting sensory and motor information between the brain and the rest of the body. Nerves branch out from the spinal cord through openings between the vertebrae, known as intervertebral foramina, to innervate specific regions and facilitate communication within the nervous system.

The complexity and precise interaction of these anatomical components contribute to the spine’s remarkable role in supporting bodily movement, providing structural stability, and facilitating neural connectivity.

Common Traumatic Back Injuries

The spine is a complex structure that can be susceptible to various types of fractures and traumatic injuries, some of which can be particularly severe. Here are some of the most serious back fractures and traumatic back injuries:

Compression Fractures: a compression fracture is a type of bone fracture that occurs when a vertebra, one of the bones of the spine, collapses in on itself due to pressure. This pressure could be the result of a traumatic injury, such as a fall or a car accident, or it could be due to a disease that weakens the bones, such as osteoporosis or cancer.

Compression fractures most commonly occur in the thoracic (middle) and lumbar (lower) regions of the spine. They can lead to pain, decreased height, limited mobility, and in severe cases, damage to the spinal cord.

Symptoms of a compression fracture can include:

• Sudden onset of back pain
• Worsening of pain when standing or walking
• Some pain relief when lying down
• Decreased mobility and loss of height over time
• Over the long term, the shape of the spine can change, leading to a stooped posture known as kyphosis.

The diagnosis is typically confirmed through imaging tests such as X-rays, CT scans, or MRI scans. Treatment options can range from pain management and physical therapy to surgical procedures depending on the severity of the fracture and the overall health of the individual.

Burst Fracture: a vertebral burst fracture is a more severe form of a compression fracture that happens when a vertebral body in the spine collapses in multiple directions. Unlike compression fractures, where the fracture usually occurs only in the front part of the vertebra, a burst fracture implies that the entire vertebral body has been affected.

This type of fracture indicates a high-energy injury and can result from a severe trauma such as a fall from a great height or a car accident. Burst fractures often involve the dispersal of bony fragments into surrounding structures, and they carry a higher risk of spinal cord injury or nerve damage compared to compression fractures.

Because of the severe nature of these fractures, treatment often involves surgery, especially in cases where the spinal cord is affected. However, in some less severe cases, non-surgical treatment involving immobilization in a brace may be appropriate. The specific treatment plan will depend on various factors, including the specific details of the fracture, the patient’s overall health, and the presence of any neurological symptoms or injuries.

A comprehensive diagnosis of a vertebral burst fracture typically includes clinical examination and imaging studies such as X-rays, CT scans, and MRI scans. These help determine the extent of the fracture and any associated spinal cord or nerve injury.

Flexion-Distraction (Chance) Fracture: a flexion-distraction fracture, also known as a Chance fracture, is a specific type of spinal injury that typically occurs in the thoracolumbar region (where the lower part of the thoracic spine meets the upper part of the lumbar spine). This fracture usually happens when the upper body is flexed forward while the lower body is restrained or fixed in place, resulting in a horizontal splitting of the vertebra.

The term “Chance fracture” comes from the nature of the injury – it often happens due to high-energy events such as car accidents when a passenger is wearing a lap belt without a shoulder strap. The upper body is thrown forward while the lower body is held in place by the lap belt, causing the spine to bend excessively over the belt, leading to a horizontal fracture through the vertebral body, pedicles, and spinous process.

Symptoms of a Chance fracture can include severe back pain, bruising and skin markings over the fracture area, abdominal injuries, and neurological symptoms like numbness or weakness in the lower limbs if the spinal cord is affected.

Diagnosis usually involves a clinical examination followed by imaging studies like X-rays, CT scans, and MRI scans to fully understand the extent of the injury. Treatment typically involves surgical stabilization of the spine, but non-surgical methods may be considered in certain cases without neurological involvement. The specifics of treatment depend on the severity of the injury, the patient’s overall health, and any associated injuries.

Fracture-Dislocation: a vertebral fracture-dislocation is a severe spinal injury where a fracture and dislocation occur concurrently, typically involving the same vertebra. In this type of injury, a bone in the spine fractures and at the same time one of the vertebrae becomes dislodged (dislocated) from its normal position.

This is a serious condition because it often involves damage to the spinal cord, given the close proximity of the vertebrae to the spinal cord within the spinal canal. Depending on the extent of displacement of the vertebra, there can be varying degrees of injury to the spinal cord ranging from minor and reversible neurological deficits to complete spinal cord injury leading to paralysis.

The injury often results from high-energy trauma, such as falls from great heights, motor vehicle accidents, or sports injuries.

Symptoms can include severe pain, loss of movement or sensation below the site of the injury, problems with balance and coordination, and potentially loss of bowel or bladder control.

Diagnosis involves a clinical examination and imaging studies like X-rays, CT scans, and MRI scans to assess the extent of the injury, the degree of spinal instability, and any associated injuries, particularly to the spinal cord.

Traumatic Spinal Cord Injury: a traumatic spinal cord injury is a sudden, severe damage to the spinal cord, usually resulting from a physical impact or trauma, such as a car accident, fall, gunshot wound, sports injury, or a violent attack such as a stabbing. The severity and location of the injury determine the extent of function loss.

When the spinal cord gets damaged, it disrupts the communication between the brain and parts of the body, affecting motor, sensory, and autonomic function below the level of injury. Depending on the severity and location of the injury, it can lead to partial or complete paralysis and can also affect other body functions such as breathing, bowel and bladder control, and sexual function.

The two main types of paralysis caused by spinal cord injuries are:

1. Paraplegia: This is the loss of movement and sensation in the lower half of the body, including the legs. This typically results from injuries to the thoracic or lumbar spinal cord.
2. Quadriplegia (also called Tetraplegia): This involves loss of movement and sensation in all four limbs (arms and legs) and the torso. It typically results from injuries to the cervical (neck) region of the spinal cord.

The extent of paralysis can also be categorized as either:

1. Complete: There’s no function below the level of the injury; both sides of the body are equally affected. This means there’s no sensation or voluntary movement in the body parts controlled by the affected areas of the spinal cord.
2. Incomplete: There’s some function below the level of the injury, which may be partial or full. The degree of function in an incomplete spinal cord injury varies widely from person to person and may improve with rehabilitation and physical therapy.

Victims of spinal cord injury often necessitate lifelong care due to the persistent nature of the damage to the central nervous system. These impairments lead to significant functional limitations, necessitating continuous assistance with activities of daily living, including mobility, personal hygiene, and bowel and bladder management. Furthermore, these individuals are at an increased risk for medical complications such as pressure ulcers, urinary tract infections, respiratory complications, spasticity, and chronic pain, all of which require ongoing medical management. They often also require long-term rehabilitative therapies including physical therapy, occupational therapy, and psychological support for mental health issues such as depression and anxiety. In many cases, adaptations to the home and work environment, as well as the need for assistive devices and specialized equipment, form a critical part of ongoing care. The ultimate goal is to maximize functional independence, improve quality of life, and prevent secondary complications.

Disk Herniations: in addition to fractures, traumatic back injuries can also involve intervertebral discs, which are the cushion-like structures between the vertebrae. Disc herniations occur when the outer layer of a disc tears, causing the inner gel-like material to protrude. Common types of disc herniations include:

1. Bulging Disc: A bulging disc occurs when the disc protrudes slightly beyond its normal boundaries, often due to wear and tear or degenerative changes. It may or may not cause symptoms.
2. Herniated Disc: A herniated disc, also known as a slipped or ruptured disc, happens when the inner material of the disc breaks through the outer layer. This can lead to compression of nearby nerves, resulting in pain, numbness, or weakness in the affected area.
3. Extruded or Sequestrated Disc: In more severe cases, a disc herniation can progress to an extruded or sequestrated disc, where the inner material completely separates from the disc. This type of herniation can cause more pronounced nerve compression and often requires medical intervention.

It’s important to note that the severity and consequences of these injuries can vary widely depending on the specific circumstances of the trauma, the location of the injury, and individual factors. Seeking immediate medical attention is crucial in cases of suspected back fractures or traumatic back injuries to ensure a proper diagnosis and appropriate treatment.

Back Surgery after a Motor Vehicle Accident

The following are some of the most common back surgeries which we have seen after traumatic injury:

Laminectomy: This is a surgery that creates space by removing the back part of a vertebra (lamina) that covers your spinal canal. The removal enlarges your spinal canal and is performed to relieve nerve pressure caused by spinal stenosis, which can result in pain, weakness, or numbness.

Discectomy: This surgical procedure is performed to remove a herniated intervertebral disc that is pressing on a spinal nerve or the spinal cord and causing pain. Discectomies can be performed as open surgeries or minimally invasively, through microdiscectomy, which uses a smaller incision.

Foraminotomy: This surgery is performed to relieve pressure on nerves that are being compressed by the intervertebral foramina, the passages through the vertebrae through which spinal nerves run. The surgery involves removing bone or tissue to open the nerve root exit, relieving compression.

Spinal Fusion: In this surgical procedure, two or more vertebrae are permanently connected. Bone or a bone-like material is placed between the two vertebrae. Metal plates, screws, and rods may be used to hold the vertebrae together, so they can heal into one solid unit. This is often used to stabilize the spine after a herniated disc, spinal stenosis, spondylolisthesis, or tumors.

Artificial Disc Replacement: In this surgery, a damaged disc that’s causing pain is removed and replaced with an artificial one made of metal or plastic. It’s an alternative to spinal fusion and is used to maintain normal neck movement and reduce the chances of adjacent level degeneration.

Vertebroplasty and Kyphoplasty: These minimally invasive procedures are performed to treat spinal compression fractures by stabilizing the broken vertebra with the injection of a medical-grade bone cement. In kyphoplasty, a balloon is first inserted into the fractured bone to create a cavity before injecting the cement.

Spinal Decompression: This type of surgery is used to relieve pressure on one or many nerve roots in the lumbar spine. It can be performed as a laminectomy, foraminotomy, or osteophyte removal, depending on the cause of nerve root compression.

Microdiscectomy: This is a minimally invasive procedure where the portion of a herniated nucleus pulposus that’s pinching a nerve root is removed. A small incision is made and a microscope is used to view the disc and nerves.

Anterior Cervical Discectomy and Fusion (ACDF): In this procedure, a herniated or degenerative disc in the neck is removed through a small incision in the throat area. After the disc is removed, the vertebrae above and below are fused together, often using a graft.

Posterior Cervical Fusion (PCF): In this surgery, the vertebrae are fused together in the back side of the spine. The operation stabilizes the cervical spine and can relieve pressure on the spinal cord if cervical discs have collapsed or if there’s instability.

Can I get Compensation for a Back Injury?

The answer is that it’s most likely (assuming that the injury is NOT work related). In Ontario, in order to receive compensation your injuries must be considered “serious and permanent”.

In Ontario, the law says that if you’ve been in a car accident and you want to claim money for your pain and suffering, your injuries have to meet a certain level of seriousness, known as the “threshold.” This rule is a way to make sure that only people with serious and lasting injuries can claim these kinds of damages.

The law defines “serious” as something that really affects your life. This could be an injury that stops you from working your regular job, makes it hard for you to study for your career, or just affects your everyday activities.

“Permanent” means your injury is lasting and won’t go away, according to what doctors think. Even if you’re trying your best to get better, like going to rehab or therapy, the injury is expected to last for a long time.

The threshold is an important part of the rules about car insurance in Ontario. It helps to make sure that the insurance companies can pay for the people who are most seriously injured in car accidents. But remember, this rule only affects your claim for pain and suffering. It doesn’t stop you from claiming for other things, like lost wages or medical costs.

What we can say is that in most cases we have seen – injuries that require back surgery will normally interrupt a person’s daily activities and/or work over time due to post-operative or degenerative complications.

Postoperative complications after back surgery can be multifaceted and include both general surgical risks and those specific to spinal surgery. One of the potential complications is the development of adjacent segment disease (ASD). ASD refers to degenerative changes at spinal levels contiguous to a previous surgical site, leading to conditions like disc herniation. This phenomenon is often a result of altered biomechanics and increased load transfer to the discs above and below the level of surgery.

For instance, if a lumbar fusion surgery is performed at L4-L5, the increased mechanical stress on the adjacent levels (L3-L4 and L5-S1) can lead to accelerated degeneration of these segments. Disc herniation at these levels can occur due to this additional stress, manifesting in symptoms similar to those preceding the initial surgery – radicular pain, numbness, or weakness in the distribution of the affected nerve root.

Another potential complication is failed back surgery syndrome (FBSS), characterized by persistent or recurrent pain following spinal surgery. FBSS can occur due to several reasons, including but not limited to, recurrent disc herniation, nerve damage, or spinal instability.

Another long-term complication is post-traumatic osteoarthritis.

Post-traumatic osteoarthritis (PTOA) is a form of arthritis that develops following trauma or injury to a joint, including spinal trauma that necessitates back surgery. In the spine, this condition is associated with the degeneration of intervertebral discs and facet joints, the two primary structures that bear weight and facilitate movement.

In the event of a traumatic injury necessitating back surgery, the normal anatomical structure and biomechanics of the spine can be altered, leading to abnormal distribution of forces across the intervertebral discs and facet joints. Over time, this aberrant stress can accelerate the wear and tear process, leading to degeneration of cartilage and subsequent bone remodeling, hallmarks of osteoarthritis.

Symptoms of post-traumatic osteoarthritis in the spine can include chronic back pain, stiffness, decreased range of motion, and potential neurological symptoms if there is nerve root or spinal cord compression. This condition may significantly impact a person’s quality of life, as it can limit physical activity and lead to chronic pain.

Moreover, there are risks of dural tear leading to cerebrospinal fluid leakage, surgical site infections, or hardware malfunction in case of instrumentation. These complications may necessitate further intervention, prolonging recovery and potentially leading to long-term disability.

Have you been hurt in a Serious Accident? Our Hamilton Personal Injury Lawyers can help.

Our Hamilton Personal Injury Lawyers have been serving accident victims in the Hamilton community for over 20 years and can hel you or your family in a time of need. We’ve recovered millions for accident victims throughout Southern Ontario who have suffered the most horrific injuries and the most devastating losses. If you have been hurt as a result of someone’s negligence, it’s important that you contact us so that we can assist in setting up the proper no-fault benefits, hiring the proper occupational therapist before your insurance company hires their own, and ensure that all timeline requirements are met.

If you are local in Southern Ontario, call our personal injury lawyers today to discuss your back surgery, at 905-333-8888. You cal also our injury lawyers toll free at 1-844-525-2633 from anywhere in Canada. Alternatively, you can send us a confidential email through our website and we would be happy to get right back to you, and help schedule your free consultation today.