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The Use of an MRI in a Case Involving Neck or Back Pain

People who have been involved in car crashes and other vehicle accidents commonly experience whiplash, resulting in neck, back and spine injury. In treating these injuries, doctors often have patient’s pursue conservative treatment, generally consisting of medication, along with chiropractic sessions or physical therapy. When that treatment is unsuccessful in reducing their symptoms, doctors commonly order a Magnetic Resonance Imaging or MRI to aid in their diagnosis. The results of the MRI have the potential to make a big difference in the value of the injured person’s case.

We see clients whose medical records show constant and persistent complaints of neck or low back pain, but have negative MRI findings. That does not mean they have no injury. Too many doctors and lawyers focus only on an injury to the disc of the spine readily shown on MRI. Significant pain symptoms may just as easily result from damage to the ligaments which stabilize the spine. Sometimes other tests, such as a motion x-ray, may be required to document an injury to those ligaments as the source of their pain complaints.

Many clients with neck and back pain do show positive, abnormal MRI findings. The most common disc abnormalities are a bulging disc, protrusion, or herniated disc. There is a great deal of misunderstanding about what these terms mean. Different radiologists, looking at the same MRI film often label the abnormal finding differently. For instance, a bulge to one may be read as a herniation to another. It becomes more complicated when there is a major difference of opinion by well-trained radiologists interpreting the same MRI film. We have experienced cases in which a treating radiologist interpreted an MRI as showing a herniation, only to have a defense hired radiologist read the same MRI as being essentially normal.

Further, some studies have shown that a percentage of the population (some say as high as 40%) may have an abnormal disc (a bulge, protrusion, or herniation) without experiencing any pain complaints and have never been in an accident. With that in mind, how can it be proven that an abnormal MRI finding following an accident resulted from that accident and did not preexist it? This is a major issue that exists in many cases.

Some radiologists suggest observations on an MRI which give indications of whether the abnormal finding had been present for some time (preexisted) or whether it was an “acute” (recent) finding. Commonly, however, such clues are not seen on the MRI films. The focus of attention in virtually all cases is the patient’s prior accident history, as well as an examination of their medical records to determine if complaints of pain in the same area had been reported before the accident in question. A history of trauma, especially when combined with complaints of pain to the same area of the neck or back, invariably results in the defense arguing that the condition existed before the accident.

The insurance company is always focused on finding some way to argue that any neck or back injury complaints must have been present long before the accident in question. This is so even when there is an abnormal MRI finding. They go to great lengths to find out if the person had ever injured their neck or back in some prior accident or had ever complained of neck and back pain in any medical record in their past. If they are unsuccessful in finding prior accidents, they will also review all prior medical records they can locate. Finding such complaints may help them argue the injury existed before the accident, particularly when complaints of neck or back pain are close in time to the accident in question. Insurance companies know that juries award less money for an injury which is an aggravation of some previously existing condition. A case has the greatest value when there is no history of prior neck or back injury and no history that the person had complained to their doctor sometime in the past of neck or back pain.

Clients who have experienced a prior injury or had complaints of neck or back pain in the past, know how they felt before and how much worse they feel after the accident in question. When adjusters evaluate cases, too much emphasis is placed upon what the medical records show and how complaints are described. Too many medical records are not carefully written. All too often, neck or back complaints are described too generally. Consequently, it is difficult for an adjuster or a jury to distinguish the difference between an old complaint of neck or back pain and complaints following a new accident. This is frustrating to an injured client who can actually tell the difference in the level or intensity of their pain after a new injury. The existence of prior similar injuries or complaints of similar pain are the leading factors in reducing the value of an injury case, even when there are positive, abnormal MRI findings.

It is important to keep in mind that doctors treat patients based on their pain complaints, not simply on the fact that an MRI shows a big disc injury. While MRI findings of disc injury are enormously important in the value of a case, in non-surgical cases they are not always the most controlling factor. The disc injury must be causing pain, diminished range of motion, headaches or other complaints which require treatment. A patient's clinical complaints, what they tell their doctor about their pain, are enormously important in evaluating disc injury seen on MRI. How the client feels, their complaints, the kind of treatments they require, how long treatment is required, how they respond to treatment and how the injury permanently affects their activities of daily living all play an important role in determining the value of their case. The MRI finding is only the beginning.

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