Spine Injury - Medical Malpractice LawyersLEGAL HELPLINE: ☎ 855 804 7125
Fractures and dislocations of the vertebrae which make up the spine are considered serious due to the danger of damage to the spinal cord which passes through each of the vertebrae. Injury to the vertebrae which impinges on the spinal cord can give way to a secondary chain of events which results in ischemia (restricted blood flow), hypoxia (lack of oxygen reaching body tissues), oedema (abnormal accumulation of excess fluid in connective tissue) and ultimate infarction (death due to restriction) of the spinal cord which can cause severe disablement including paraplegia and quadriplegia.
A spine injury or a spinal cord injury caused by the negligence of another person entitles the victim to take legal action in order to claim compensation for personal injury and loss. If you have suffered a serious back injury you should take urgent advice from a spinal injury lawyer without delay.
Our specialist spine injury medical malpractice lawyers deal with personal injury settlements on a full contingency basis. You do not have to fund or finance your potential damages claim in any respect. Our negligence lawyers are experienced in high value personal injury claims. If you have suffered a spinal injury as a result of negligent actions by a third party our spine injury lawyers will fully investigate the legal issues and advise in early course about our view on liability and the estimated value of the likely personal injury award.
We offer free consultations and our spinal cord injury lawyers will accept no legal fee until such time as money is successfully recovered a result of the legal action we take on your behalf. Our lawyers never accept any payment whatsoever until the personal injury case is settled and payment of all damages has been received. All necessary enquiries and investigations will be carried out on your behalf, at our expense with no cost to you or your family.
Statute of Limitation
A statute of limitation applies in all personal injury cases throughout Canaa, dictating and determining when legal action becomes statute barred therefore precluding a spinal injury lawyer from filing a writ, ensuring that the opportunity to claim compensation for personal injury caused by third party negligence may be lost forever. The relevant time limit varies dependent not only on the location but also dependent on the age and the mental capacity of the victim. Matters relating to limitation can be complex legal issues, and often vary from one location to another and may depend on the identity of the proposed defendant. You should take urgent legal advice from a qualified lawyer as soon as there is any suspicion that personal injury may have been caused by negligence in order to ensure that you are able to comply with the limitation requirements.
The Anatomy of the Spine
In order to understand spinal injuries, it is important to first discern how this complicated part of the anatomy works. The back includes the muscles, tissues and bones of the posterior portions of the trunk. The back is of the utmost importance in posture, support of weight, locomotion and protection of the spinal cord and spinal nerves.
The bones of the back form the vertical column, which consists of 33 vertebrae, 24 of which make up the movable pre-sacral vertebrae, the sacrum and the coccyx. The first 7 are called the cervical vertebrae (neck), the next 12 are known as the thoracic vertebrae (upper back) and the following 5 lumbar vertebrae (lower back). Below the lumbar vertebrae are the 5 inflexible sacral vertebrae and, lastly, 4 small bones forming the coccyx (tailbone). These vertebrae too are amalgamated.
The vertebral column, with its muscles and joints is the axis of the body, a pillar capable of both rigidity and flexibility. The head pivots on it and the upper limbs are attached to it. It completely surrounds or encases the spinal cord and it partially shields the thoracic and abdominal organs. It transmits the weight of the rest of the body to the lower limbs and ground when standing.
The Spinal Cord
Spinal cord injuries are among the most devastating injuries a person can sustain. Such injuries can be due to a blow to the body, such as in a motor vehicle accident, a fall from height, diving injuries or a penetrating injury, such as that seen in stab wounds or gunshot wounds. Such injuries can damage ligaments and bones but more importantly, the spinal cord can be injured. The spinal cord is responsible for sending all the nerves from the brain down the spinal canal, sending out spinal nerves at various intervals.
The spinal cord contains grey matter that controls reflexes and white matter that conducts pulses to and from the brain. The spinal cord is connected directly to the brain via the neural canal of the vertebral column and has two principal functions :-
It provides a means of neural communication to and from the brain through tracts of white matter. Ascending tracts conduct impulses from sensory receptors of the body to the brain. Descending tracts conduct motor impulses from the brain to the muscles and glands.
It serves as a centre for spinal reflexes. Specific nerve pathways enable some movements to be reflexive rather than initiated voluntarily by the brain. Movements of this type are not confined to skeletal muscles; reflexive movements of cardiac and smooth muscles control heart rate, breathing rate, blood pressure, and digestive activities. Spinal nerve pathways are also involved in swallowing, coughing, sneezing, and vomiting.
Fractures of the Cervical Vertebrae
Fractures of the cervical vertebrae are usually caused when the upper spine is over-extended due to hyperflexion of the neck. This means that the head has been forced forward while the neck is held back by the rest of the body. This typically happens with a blow or impact, as well as rapid deceleration. Such injuries occur in motor vehicle accidents and from a blow to the head by a heavy object. The effects of these injuries are generally life-long disability of varying degrees.
Spinal Cord Injuries
The spinal cord can be crushed or it can be transected or cut completely as a result of trauma. The spinal cord can be compressed by a hematoma or blood clot pressing on it. Some more fortunate patients have just a hemi-transection or partial tear in the spinal cord so that a portion of the spinal cord is spared. The spinal cord can just be swollen because of blunt trauma; which may result in resolution of the injury and recovery of function in due course.
Spinal cord injuries occur most frequently in the fifth, sixth and seventh cervical, the twelfth thoracic and the first lumbar vertebrae, because there is a greater range of mobility of the vertebral column in these areas.
If there is progressive loss of neurological function, a decompressive laminectomy may have to be performed. An unstable fracture of the cervical spine may call for early skeletal fusion – the joining of bones to prevent movement and further damage. However, any operation on the cervical spine produces a danger of respiratory difficulty and should be very carefully considered as the consequences are permanent.
Paralysis is a permanent loss of motor control, usually resulting from disease or lesions on spinal cord specific nerves. Paralysis of both legs is called paraplegia. Paralysis of both the arm and leg on the same side is called hemiplegia, and paralysis of all four limbs is quadriplegia. Paralysis may be flaccid or spastic. Flaccid paralysis means that no control or movement is possible. It is characterized by muscles that atrophy over time. Spastic paralysis is characterized by hypertonicity (muscle tightness) of the skeletal muscles.
There are three levels in the spinal cord that can become injured. These include the cervical, the thoracic and the lumbar levels. The worst of these to have is a cervical injury. These are relatively common due to the fact that the neck is not well supported. There are seven cervical vertebrae which can be injured and all of these injuries lead to some aspect of quadriplegia, which is paralysis of the upper and lower extremities both. If you get damage above C2, you cannot breathe on your own and must live on a respirator for the rest of your life. If you suffer damage at C5, you lose everything below the extension of the wrist. If you lose C7, your fingers are affected. Even damage at T1 affects the upper extremity but only the part belonging to the little finger.
Whiplash is a sudden hyperextension (stretching) and flexion (bending) of the cervical vertebrae, which typically occurs in rear-end automobile collisions. Recovery from minor whiplash (muscle and ligament strains) is generally complete, but may take an extended period of time. Severe whiplash (spinal cord compression) may cause permanent paralysis.
A spinal cord hematoma can happen if a bullet came close to the spinal cord or if a knife or other sharp object came close to but did not injure the spinal cord itself. A hematoma is a blood clot, found often pushing on the cord due to the space effect of the hematoma. Pressure that is too great can result in a spinal cord infarction or “stroke” in the spinal cord. These can lead to paralysis similar to transection but more often, there are sporadic areas of function loss that are not as bad as if a transection occurred.
Another problem that can happen in a spinal cord injury is what’s called a central cord syndrome. In this syndrome, only the middle portion of the spinal cord suffers from damage and this results in a loss of fine motor control in the upper extremities and lesser problems in the lower extremities. Most people retain their bladder function if they develop central cord syndrome.
If you suffer damage to the thoracic area of the spine, the entirety of the lower extremity is involved and you develop what’s known as paraplegia. Your arms are unaffected. Fortunately, the thoracic spine is well protected and is injured most in penetrating wounds or serious falls.
In the lumbar region, there is less protection to the spine, it twists more, and it is more prone to injury. If L2 is affected, you lose your ability to flex at your hips. If L3 is damaged, you lose your ability to extend at the knee. If L4 is involved, you have problems functioning below the ankle. If L5 is affected, the only symptoms you will have is that of inability to extend your great toe. Rarely, S1 becomes involved in the injury and, in those cases; you lose the ability to extend at your ankle.
A spinal cord injury is a medical emergency so you should call the emergency services any time you suspect a person has suffered a spinal injury. Even if there is just a chance of a spine injury, make sure the injured person keeps their spine still until an emergency medical technician puts a cervical collar on and send the patient to the emergency room for x-rays. Moving about in thoracic and lumbar injuries is less serious but, to be on the safe side, do not move the patient if at all possible.
At the emergency room, x-rays will be taken, including a CT scan or MRI scan of the spinal cord, which will identify areas of swelling, transection or partial transection. This person should have protection around the affected area at all times until the patient is taken to the surgical suite. There, the doctors will stabilize the spine and remove any fragments of bone from the spinal canal and spinal cord. Hematomas are removed and the patient is placed in a semi-permanent device that keeps the spine straight and allows it to heal. If the spinal cord is crushed, swollen or has a hematoma, there is hope for recovery. If the spinal cord is transected, it cannot be stitched back together and there will be paralysis below the level of the transection.
Doctors have medical ways to help improve the function of the spinal cord, especially in cases of swelling of the cord. Methylprednisolone, if given within eight hours of injury, can reduce the swelling of the swollen areas of the spinal cord. Oxygen is given to provide as much oxygenation to the damaged tissue. In fact, spinal cord patients should receive 100 percent oxygen for the first few days of their injury.
The most effective way to minimise damage of any spine injury on arrival to a medical facility is by immediate immobilisation. Immobility of the vertebral column can be achieved in a number of ways: with a spinal splint, cervical collar, traction or skeletal traction. This first approach is utilized unless the patient is transported directly to a spinal specialty unit where X-rays and scans can be performed to determine the extent of the damage. Treatment in a hyperbaric chamber has often been found to be beneficial and can lead to shorter recovery times.
Due to patient immobilisation, it is necessary to give anti-nausea medication to prevent choking. Pain management is also important and appropriate medication can be administered intravenously.
Within the first day after the injury, steroids are often administered in order to stimulate the spinal cord. This treatment can greatly enhance the recovery time and prospects of the patient if it proves successful.
When a full analysis of the exact extent of the spinal injury is complete, then consideration is given to other bodily functions to bring bowel and bladder functions under control. Finally, a feeding tube is inserted.
Ongoing treatment is prevention of bed-sores and this requires a lifting frame or four experienced personnel. The patient is lifted periodically for short periods of time to relieve pressure areas in constant contact with the bed.
A high percentage of people who suffer spinal injury do not recuperate fully, but the degree of recovery varies greatly between restriction of movement to total and permanent paralysis.
Whatever the recovery rate, the duration of rehabilitation is usually long, lasting anywhere from six months to many years. Intensive specialist treatment is needed, especially in the area of physiotherapy, hydrotherapy, occupational and speech therapy.
Pain management is another ongoing concern, even among those who regain their motor functions. Sometimes pain medication is a lifelong necessity for a person suffering a spinal injury.
Spine Injury Lawyers
If you sustain a spine injury and you suspect the cause of the injury was due to the negligence of someone else, see a spinal cord injury lawyer. He or she will evaluate your case and decide whether or not there was negligence on the part of another person. If this is the case, the lawyer goes through your medical records and talks to your doctors about what your expected long term prognosis is. They determine the amount you should receive as compensation by looking at the degree of disability you have, what kind of pain and suffering you went through, what income you have already lost since the injury and what income you will expect to lose in the future because of your injury.
Not all doctors do an adequate job of treating spinal cord injuries and this can result in a worsened outcome than would otherwise have happened. If you believe this is your situation, seek the advice of a spine injury medical malpractice lawyer who will review the chart and let you know if the treatment was optimal. You may be entitled to compensation for your worsened condition, loss of wages, disability care and pain or suffering.
Spinal injuries can occur with sports injuries, severe falls, other violent injuries, gunshot injuries and motor vehicle injuries. Many spinal injuries affect the spinal cord and cause paralysis. Statistically over 40,000 individuals in Canada have spinal cord injuries and new cases top 1,000 cases each year. Most of the injuries occur in men, especially between the ages of 16 and 30 years (about 80 percent). The damage to the spinal cord can cause dysfunction of the sensory and motor function of the lower extremities or upper and lower extremities together. The spinal cord does not have to be severed completely in order to have a spinal cord injury. You can also break your back and cause a spinal injury that does not affect the spinal cord at all. In such cases, doctors can stabilize the vertebrae of the back and no paralysis results.
A spinal cord injury can affect anywhere from the base of the skull to the sacrum. The spinal cord extends from just below the brainstem to about the mid waist. After that the spinal cord breaks up into several spinal nerves that travel down to the other vertebral openings until it reaches the low back and sacrum. If the spinal cord is injured, there is no information passed beyond that point and paralysis ensues. The higher the level of the spinal cord injury, the more of the spinal cord is not working.
The nerves in the spinal cord are called upper motor neurons and the branches that branch out of the spinal cord are called lower motor neurons. The peripheral nerves of the body are also called lower motor neurons. When the upper motor neurons are affected, there is paralysis and spasticity of the affected muscles below the level of the damage. If the lower motor neurons are affected, there is flaccidity of the muscles at the level of the injury. There are both sensory and motor nerves in the spinal cord and both are affected in a spinal injury.
The spinal cord is generally protected by the vertebrae. If these bones travel out of proportion to one another, such as in a twisting or lateral injury, the spinal cord can be stretched or severed, resulting in a spinal injury. The top vertebrae include C1-C7 vertebrae, the cervical vertebrae. They result in quadriplegia if the spinal cord is affected. Vertebrae below that are T1-T12, which, if injured, result in paraplegia. Damage to L1 to L5 can also affect the lower extremities as well but to a lesser degree. Quadriplegia involves damage to both arms and legs. Paraplegia involves damage to the legs only and sometimes the trunk.
Effects of spinal cord injury depend on how complete the spinal cord is transected. The spinal cord can be cut just in half, leading to problems on one side of the body but not so much on the other side of the body. The motor neurons cross over so the opposite side of the body is affected but the sensory nerves do not cross over in the spinal cord, so the same side of the body is affected with loss of sensation. An incomplete injury means that some function is preserved and some function is not preserved.
There are excellent treatments for spinal cord injuries of late so there are more people who have some function below the level of the injury than before, with the exception of a transected cord. Rehabilitation has done a great deal to preserve some of the function of the nerves below the level of the injury.
Cervical injuries to C1 down to C7 result in paralysis of the arms and legs. If the cervical injury is above C4, there may need to be ventilator support for breathing. C5 injuries affect the shoulder and biceps control. C6 injuries damage everything down to the wrists. Injuries to C7 and sometimes T1 allow you to have no function of the hands or the rest of the upper extremities.
T1 to T8 injuries involve truncal problems and an inability to sit without support. Legs are also affected. If the injury is low, at T9-T12, the trunk functions well but the legs are affected. The legs are completely paralyzed at that level. Lumbar and sacral problems to the spinal nerves affect varying muscles of the legs, with foot control, bowel and bladder function being affected the last.
A spinal fracture is serious. Most of these fracture injuries occur in the midback or thoracic area and in the lower back or lumbar spine. These are fractures that primarily occur by high velocity accidents, such as a fall from a great height or an automobile accident. Men are victims four times more often than women and senior citizens are at higher risk secondary to their higher incidence of osteoporosis, which weakens bones.
Because these are high velocity injuries, these patients often have other injuries that take precedence over the spinal fracture but because of the nature of spinal fractures, they must be kept in mind at all times during the stabilization process. The chance of spinal cord injuries is always possible in a spinal fracture.
Causes of spinal cord injuries are high energy trauma including a car crash, a fall from height, a sporting injury, or a violent act like a penetrating gunshot wound. Spinal fractures do not always have to be caused by trauma. Tumors, osteoporosis, or underlying conditions that weaken bone can fracture a vertebra, even during regular daily activities.
There are different kinds of spinal fractures that are classified according to whether or not the spinal fracture occurred and caused a spinal cord injury. This classification syndrome helps to determine the proper treatment. The three major fracture types include flexion injuries, extension injuries and rotational injuries.
Under the category of flexion fractures, there are compression fractures, where the front of the vertebra loses height. This is generally a stable fracture. Axial burst fracture includes loss of height anteriorly and posteriorly. It results from a fall from a great height.
Under the fracture type extension pattern, there is a flexion/distraction fracture. The vertebra is literally pulled apart or distracted. It is a common injury when there is a car accident in which the head is pulled forward and the lap is restrained by the seat belt.
Under the category of rotational fractures, there are transverse process patterns that result from rotation or extreme lateral bending. They are uncommon and affect stability. A fracture dislocation can occur that involves bone and soft tissue. It is an unstable injury because the vertebra can move away from the vertebra above or below it. Serious cord compression is possible.
The main symptoms of a spinal fracture include moderate to severe back pain made worse by movement. When the spinal cord is affected, there is numbness, weakness, tingling, or bowel and bladder dysfunction. There may be injuries or unconsciousness that takes over the back pain making it difficult to diagnose.
Treatment involves emergency stabilization from the EMS rescue workers who should suspect a spine fracture in any severe motor vehicle accident. Before moving the patient, the EMS team should have the patient in a spine back board and a cervical collar.
The emergency room doctor will do a thorough physical exam, including the spine. Neurological tests should be performed that test sensation and movement of all the limbs. Imaging studies such as an MRI scan or CT scan of the spine can tell what kind of fracture a person has and how severe the fracture is.
Most flexion injuries are treated nonsurgically, with a brace for the back for 6-12 weeks. The patient increases activity gradually and undergoes rehabilitation exercises.
Surgery is used for unstable burst fractures that have many fracture fragments, if there is severe loss of vertebral height, if there is angulation or forward bending of the spine, or if the disk is pinching is interfering with the spinal cord. Unstable fractures such as these need to be treated surgically by decompressing the spinal cord and removing parts that are impinging on the cord.
Medical Malpractice Lawyers
The medical profession which includes doctors, nurses and hospital technicians usually provides a caring service with a high standard of excellence however there are occasions when things do go wrong. Our litigation service is completely free and our lawyers will deal with your case using a contingency fee arrangement which means that if you don’t succeed in receiving a financial settlement then your spine fracture lawyer won't get paid.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here