Posted on September 29, 2024
Many people suffer long-term injuries after motor vehicle accidents (MVA). Often through no fault of their own, they have been subjected to an extreme physical force to their body, impacting the neck and lower back. In addition, these injuries often create an accelerated, premature degenerative cascade and aging of the spine, which can lead to future problems.
Unfortunately, many clinicians believe that MVA injuries are due to muscle/ligament sprain or strain. However, these soft tissue injuries would always resolve after 1 2 weeks. Pain lasting longer than this certainly has an anatomic basis, which needs to be properly diagnosed and treated.
Several studies have shown that wherever your pain is at the 6 month mark is where it remains long term (without treatment). For this reason, early treatment is indicated to minimize the long-term impact of such accidents on your spinal anatomy.
The most common injury after an MVA is that of a cervical whiplash. When you are impacted from the rear, your neck is forcibly thrown backwards into the headrest. Then, it rebounds forward with your chin hitting your chest, and then there is a significant rebound backwards. This all happens in milliseconds! This whiplash can injure both the discs and the facet joints of your neck. In addition, it can result in severe headaches as well.
If the pain is located on the sides of your neck, it often emanates from cervical facet joints. There are paired joints at each of the seven vertebral levels of the neck that can be injured. Injury to the middle and lower joints cause pain in the mid and lower neck, while injury in upper cervical joints cause upper neck pain and can cause headaches at the base of the skull (cervicogenic headaches).
It is important that the patient receive therapy shortly after any significant accident.
Chiropractic therapy can be beneficial for several months. However, persistent neck pain should be addressed by steroid injections and further physical therapy.
Usually, two sets of steroid injections will be undertaken along the neck joints (cervical facet joint injections). With the injection, steroid antiinflammatory medicine is placed along the injured cervical joints to decrease the painful inflammation.
However, iff the pain continues after the 6-month mark, it is often necessary to perform radiofrequency ablation. With this procedure, the pain emanating from the cervical joints is eliminated by heating and denervating the nerves providing pain pathways from the neck joints to the brain.
Cervical radiofrequency can work for a year or longer. If there is an associated decreased range of neck motion, sometimes your doctor will suggest that we perform a manipulation under anesthesia to continue to restore your pre-accident range of motion while your joints are numb and you are asleep.
Sometimes, the cervical discs are injured as well. If there’s pain radiating down the arm, this can respond to cervical epidural or cervical nerve root injections. This places anti-inflammatory steroid along the affected nerves causing pain down the arm. Often, patients need physical therapy and cervical traction as well.
If there is no pain down the arm, but the cervical discs have been injured, the discs can also respond to cervical epidural injections. Finally, surgery may be necessary as a last resort for severe neck and/or arm pain that is not responsive to physical therapy or injections.
The most common MVA injury we see is in the lower back is lumbar disc injury. Often, the MRI will show just bulging, tear in the disc, or a disc protrusion/herniation indicative of this low back injury. This will often re-spond to lumbar epidural injections, transforamenal injections, and associated physical therapy. If the back pain continues despite this treatment, it may be necessary to do a lumbar discogram may determine the exact disc that is injured and the extent of the injury.
If there is no response to injections, there are newer techniques to address disc pain. First, if there is a protrusion or disc tear, it may be necessary to non-surgically remove a portion of the disc (Disc-FX®). Second, we also have VIA Disc, which replenishes your original nucleus pulposis glycoproteins that have leaked out of the disc due to the injury. Finally, surgery may be indicated if there is severe lower back pain and associated sciatica that is not responding to treatment.
Finally, there could be injury to the sacroiliac joints where the pelvis meets the spine. With an accident, the sacroiliac joint and ligaments can be injured. And, if your foot was on the brake at the time of the accident, force may be transmitted up the leg to the spine and injure your right sacroiliac joint. This can respond to sacroiliac joint injections.
Injuries to the neck and low back after MVAs are common. Pain lasting more than 4 weeks must be properly diagnosed and treated for the best possible long-term outcome.