Falls Chiropractic and Injury

6009 Falls of Neuse Road Raleigh, NC 27609

(919)876-9472 (919)876-9478 FAX

RE: Sample Patient

Date: 8/3/2017

RE: Age dating C4-C5 herniated disc in a low speed crash

To whom it may concern:

Specific to Sample Patient’ case, when looking at the images there is no infiltration of calcium at the area of the protrusion type herniation of the C4-C5 disc.  Wolfe law states that a bone will adapt to the loads upon which it is placed.  When there is a herniation of an intervertebral disc, there is abnormal mechanical shearing thus creating an increase in negative charge within the joint capsule as compared to the osseous structures above and below.  As a result, the trabecular bone will give a positive charge by means of calcium (Ca⁺) that infiltrates into the injured joint¹.  This is called the piezoelectric effect¹.  This can be usually visualized beginning at a minimum of 6 months’ post trauma².  The osteophytic changes noted in other parts of the cervical spine as well as other aspects of the C4-C5 joint itself indicate previous injury.  However, the lack of calcium infiltration and osteophytic changes around the protrusion type herniation at C4-C5 indicates that this herniation is acute in nature, is causally related to the accident, and clinically correlates with the patient’s injury. A clear contrast of this can be seen in the C3-C4 old protrusion type herniation above.

In addition, there were Modic type 1 changes present on the inferior end plate of C4 and the superior end plate of C5.

According to Xiong, Huang, Cun, Aghdasi and Zhou (2012)³

Histologic studies have shown that Type 1 Modic changes are characterized by edema, vascularization, and inflammation… (pg. 1943)

The presence of Modic type 1 changes is a direct response to the trauma and indicates a recent injury due to the presence of inflammation still present in the bone.

Therefore, the herniation at C4-C5 is acute and is causally related to her accident on 5/20/2017.

Lastly, it is important to note that low impact motor vehicle collisions can and do cause serious injury to the cervical spine. It has been clearly shown in the literature that injury to the cervical spine can occur at speeds as little as 4km/h (2.49 miles per hour)⁴. To completely ascertain the amount of force that was invoked on Mrs. Patient, one needs to bring into account many factors of the dynamics of the crash. One obvious fact in Mrs. Patient case is that the bullet car’s mass was significantly greater than the target car’s mass; Mrs. Patient was in a Honda Sudan and the bullet car was a Ford SUV as documented by the crash report. This means that the bullet car’s mass was greater than the target car and thus increases the amount of force that was applied to the Mrs. Patient’s vehicle. In addition, the infrastructures of most vehicles are designed to bend and flex at higher speeds to create a crash zone. In Mrs. Patient’s accident, there was little damage to the vehicle infrastructure which affords no crash zone. This thus causes the occupants, such as Mrs. Patient, to receive more force and therefore, more injury with less speed.

References:

1. Issacson, B. M., & Bloebaum, R. D. (2010). Bone electricity: What have we learned in the past 160 years? Journal of Biomedical Research, 95A(4), 1270-1279.
2. 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.
3. Xiong, C., Huang, B., Cun, Y., Aghdasi, B. G., & Zhou, Y. (2014). Migration inhibitory factor enhances inflammation via CD74 in cartilage end plates with Modic type 1 changes on MRI. Clinical Orthopaedics and Related Research®, 472(6), 1943-1954.
4. Brault, J. R., Wheeler, J. B., Siegmund, G. P., & Brault, E. J. (1998). Clinical response of human subjects to rear-end automobile collisions. Archives of Physical Medicine and Rehabilitation, 79(1), 72-80.

Sincerely,

Richard A. Laviano, D.C.