Trauma and Activation of Pain in Pre-existing Degenerative Discs

Trauma and Activation of Pain in Pre-existing Degenerative Discs

When a victim of a traumatic event is evaluated for causally related bodily injury, an accurate and factual analysis is imperative. There are many structures that can generate pain in the body and one of the most common is the intervertebral disc. A healthy disc is comprised of two major portions, the outer rings called the annulus fibrosis and the inner fluid center called the nucleus puplosus. Scientific research has shown that the disc has nerve fibers that carry pain sensation imbedded from the edges into the outer 1/3 of the annulus fibrosis. This is the major reason that injury to the disc causes pain resulting in persistent functional losses. One of the more complex and confusing scenarios in the medical legal world is injury in the presence of pre-existing degenerative changes in the intervertebral disc. If you understand the anatomy of the disc and how this anatomy evolves in the presence of degenerative changes, the resulting bodily injury, if and when present, makes perfect sense.

Compliments of Medical Legal Art via The Doe Report (www.doereport.com). Copyright © 2010 Medical Legal Art, All rights reserved. In a paper published in 1997 by Freemont et al., the authors researched the changes in nerve endings that carry pain sensation in degenerated intervertebral discs. The comparison between healthy discs and degenerative discs was VERY interesting. The authors stated, “Therefore, as in previous studies, we measured nerve in-growth in terms of how deep within the annulus fibrosis nerves were seen and whether nerves had penetrated the nucleus pulposus. Deep nerve in-growth was defined as growth into the inner third of the annulus fibrosis, in the nucleus pulposus, or both” (Freemont et al., 1997, p. 179).

The results of this study showed that when degenerative discs at the level of pain were examined, there were a greater number of pain nerves deep into the disc when compared to healthy controls. The authors also discovered that these nerves are not “activated” until there is a pain generating event. That is why a previously asymptomatic degenerative disc and be activated by a single distinct traumatic event. It is absolutely necessary for doctors working with the traumatically injured to understand how traumatic forces contribute to bodily injury, even when there are pre-existing changes in the intervertebral disc.

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Reference:

Freemont, A. J., Peacock, T. E., Goupille, P., Hoyland, J. A., O'Brien, J., & Jayson, M. I. V. (1997). Nerve ingrowth into diseased intervertebral disc in chronic back pain. The Lancet, 350(9072), 178-181.