Car Accident Herniated Discs
Key Takeaways
- Trauma is the second most common cause of disc herniation after age-related disc degeneration.
- Loss of bladder or bowel control and numbness in the saddle area can signal cauda equina syndrome, a neurosurgical emergency.
- 85 to 90% of patients with an acute herniated disc get relief within 6 to 12 weeks without treatment.
Disc Anatomy
Each spinal disc is a cushion between two vertebrae, with a firm outer ring and a soft, gel-like center. A herniated disc is one where all or part of the disc is forced through a weakened area of that ring. The leaked material can press on nearby spinal nerves and cause pain, numbness, and weakness.
Most herniations push toward the back and side of the disc, where the outer ring has less support from the spinal ligaments. That position raises the chance of pressing on a nerve root. The lower back is the most common site and the neck is second. Most thoracic spine herniations cause no symptoms and are found by chance on MRI.
Car Accident Forces on the Spine
Trauma is the second most common cause of disc herniation, after age-related disc degeneration. A sudden axial overload, a large force driven down the length of the spine, can push disc material out through a failing outer ring on a healthy disc, and these injuries usually cause more severe symptoms at the start.
Neck discs take a different load. The lower neck overextends while the upper segments flex past their normal range, which bends the neck into an S shape in a whiplash injury. That motion can change the intervertebral discs along with the facet joints, ligaments, and nerve roots. Patients with a herniated disc often recall an event that set off their pain.
Herniated Disc Symptoms
For a herniated disc in the cervical spine, symptoms include neck pain, pain near or between the shoulder blades, numbness or tingling in the arms, pain that travels to the shoulder, arm, and sometimes the hand and fingers, and pain that gets worse when bending or turning the neck. The C6 to C7 level is the most common site of a neck herniation that causes nerve symptoms.
A herniated disc in the lumbar spine commonly causes sciatica, a sharp pain that usually shoots down one side of the buttocks into the leg and sometimes the foot, along with tingling or numbness in the legs or feet and muscle weakness. The L4 to L5 and L5 to S1 levels account for about 95% of lumbar herniations in adults between 25 and 55.
The medical term for these nerve symptoms is radiculopathy: a compressed or irritated nerve root that makes the area it serves feel painful, numb, or tingly. Compression of the bundle of nerve roots at the base of the spine causes cauda equina syndrome, a neurosurgical emergency that can cause bladder or bowel dysfunction and numbness in the saddle area. Compression of the spinal cord in the neck is called myelopathy, and hand clumsiness and trouble walking are among its signs. Any numbness, loss of movement, weakness, or bowel or bladder changes calls for contacting a provider.
Symptoms That Need Prompt Medical Attention
- Loss of bladder or bowel control, or trouble passing urine
- Numbness in the buttocks or the area between the legs
- Weakness in an arm or leg that is getting worse
- New clumsiness with buttons, utensils, or handwriting
- Unsteady walking, stumbling, or new falls
- Numbness, tingling, or loss of strength in the hands or feet
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Bulge Versus Herniation
A bulge and a herniation differ in how much of the disc’s edge is involved and how far the material moves. Radiologists use shared terms for describing lumbar disc pathology. The table uses definitions that apply those criteria.
| Report term | What the scan shows |
|---|---|
| Bulge | Disc tissue extends less than 3 mm past its normal edge around more than 25% of the disc |
| Protrusion | Material pushes out along less than 25% of the edge, with a base wider than the displaced piece |
| Extrusion | Material pushes out along less than 25% of the edge, with the displaced piece wider than its base |
| Sequestration | Displaced material has separated and is no longer attached to the disc |
Imaging for Herniated Discs
MRI is the preferred and most sensitive study for seeing a herniated disc, while plain X-rays cannot show nerve compression or disc herniation. Imaging is not indicated for a patient without red flag signs unless symptoms last 6 weeks. After a neck injury, objective radiculopathy or myelopathy and progressive neurologic change are reasons to move to MRI.
The physical exam assesses pain, muscle reflexes, sensation, and muscle strength, and may include a straight leg raise test, in which the provider lifts the straightened leg to see whether it causes pain down the leg. Other tests include CT, a myelogram, electromyography, and a nerve conduction study.
Disc changes also appear on scans of people with no pain: among 3,110 people without symptoms, disc bulges appeared in 30% of 20-year-olds and 84% of 80-year-olds, and disc protrusions in 29% and 43% of those age groups. These findings must be read in the context of each patient’s clinical condition.
An MRI report may note a high-intensity zone, a bright spot in the outer ring of the disc on T2-weighted MRI. The sign appeared in 28% of 500 patients scanned for back pain and correlated with severe tears of the outer ring and with reproduction of the patient’s pain.
Treatment Course
Anti-inflammatory medicine and physical therapy are first-line care, and physical therapy is not recommended until symptoms have lasted at least 3 weeks. Epidural injections and selective nerve root blocks are second-line options for symptoms that have lasted at least 4 to 6 weeks.
Herniated discs get better on their own or with nonsurgical treatment for 9 out of 10 people, and a provider may recommend surgery when other treatments do not relieve symptoms. Microdiskectomy is the most common procedure, and a large herniation that injures the nerves to the bladder or bowel may need emergency surgery. Surgery can bring faster recovery, while results are similar to nonsurgical care after 1 year.
Recovery Outlook
85 to 90% of patients with an acute herniated disc get relief within 6 to 12 weeks without treatment, as the body clears the displaced material. Patients who still have symptoms after 6 weeks are less likely to improve without treatment.
Herniated discs usually heal on their own within 4 to 6 weeks. Returning to all activities without pain may take several months to a year or more. About 30% of patients still have back pain after one year.
Medical Records
Medical records show when disc symptoms began and how they changed. The history should include the onset of symptoms, the location and pattern of radiating pain, and past treatments, and the exam should record weakness, sensory changes, and reflexes.
Missed visits leave gaps in that record and raise questions about what caused later symptoms, the pattern behind treatment gaps. A disc injury is one of several spine and soft tissue injuries a car accident can cause.
Keeping the car accident report, first medical visit notes, MRI reports, and therapy records in one folder keeps the timeline of a disc injury in one place. Those records show when symptoms started and how treatment progressed.
Disc Injury After a Car Accident?
A herniated disc can take days or weeks to announce itself, and insurers often argue that later symptoms came from age instead of the accident. Sam Aguiar Injury Lawyers ties your MRI reports, therapy notes, and first visit records back to the car accident. We can also pull DOT and TRIMARC traffic camera archives that reach back about six months. You pay $0 Out-Of-Pocket Forever. Schedule a free case review.