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  • Writer's pictureDr Josh Bonine DC

Disc Herniation and Causal Relationship

Disc Herniation and Causal Relationship


Objectifying intervertebral disc pathology and, most importantly, a disc herniation can be a critical component of personal injury. Using the information found on MRI to correlate bodily injury to causality is a common task for the clinician working with the traumatically injured.


MRI is a tool to help OBJECTIFY the causally related injury, so how can you date a disc herniation? The key lies in the body’s response to mechanical changes in the vertebrae/intervertebral disc complex, specifically formation of the osteophyte:

(a bony outgrowth associated with the degeneration of cartilage at joints)

In a recent study, He and Xinghua (2006) stated the objective of the research was, “To extend the quantitative prediction of the external shape of bone structure to the simulation of osteophyte formation on the edge of vertebral body” (p. 95). Basically, what resulted was a VALIDATED mathematical formula that predicts the location and timing of the formation of a vertebral osteophyte.



Understanding the adaptive power of bone (the body’s response to changes in mechanics) helps to put a timeline to disc pathology and determines whether the disc herniation was recent or was produced in the past. The authors report, “In this paper, the osteophyte formation process on the edge of a vertebral body in its mid-sagittal plane was simulated numerically” (He & Xinghua, 2006, p. 96). This has NEVER been done before. The paper goes on to say, “Osteophytes are defensive reactions of the bone to the adjusted mechanical environment” (He & Xinghua, 2006, p. 98). This is a reaction to degeneration of the intervertebral disc and therefore will identify degenerated disc vs. newly formed causally related disc herniations. The research goes on to say, “The formation of osteophytes appears to halt the process of disc slipping [that is its purpose]” (He & Xinghua, 2006, p. 98).


The paper finally reports, “However, in clinics it will actually take about more than half a year to observe the bone morphological changes to evaluate whether these changes are beneficial for the bone in the long run [when compared to the mathematical model]” (He & Xinghua, 2006, p. 101).


In conclusion, osteophytes will NOT BE PRESENT in an injury that is LESS than 6 months old. Using this timeline along with good MRI technical parameters, thorough physical examinations and proper history taking are the ONLY way to ensure that causality, bodily injury and persistent functional losses are properly identified and linked together. The causal relationship can NOT be simply a pain or subjective finding in clinic with objective finding on a report, the clinical relative interpretation and diagnosis rendering is vital.



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Reference:

He, G., & Xinghua, Z. (2006). The numerical simulation of osteophyte formation on the edge of the vertebral body using quantitative bone remodeling theory. Joint Bone Spine, 73(1), 95-101.

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