Posts Tagged ‘Herniated disk’

What Is a ‘Herniated Disk’ — The Case of the Damaged Disk

A PAIN IN THE BACK: I’m not a doctor — I’m an attorney who represents injury victims.  However, for many, many years, first as an attorney for an insurance company, now for victims of negligence, I’ve dealt with the anatomy of the back, and particularly with an ongoing problem — the bulging or herniated disk (what some people call a ‘pinched nerve’ in their back.)   Here’s a working explanation of what happens:

A CLOSER LOOK: Take a look at this anatomic diagram, which shows the structures of the spine and spinal column from the side, or profile view, as well as from a cut-through view from the top of the spine, looking down.

Here's a view of a spine with a herniated disk shown from the side and in a cutaway view for illustration.

UNDERSTANDING THE ANATOMY: The spine is made up of bony segments, or vertebrae, which house and shield the spinal column, a bundle of nerves which conducts sensation and motor signals to various parts of the body.  This particular section is the lumbar spine, or the low back (the ‘bottom’ portion of the spine).  Everyone (with certain very limited exceptions) has the same number of vertebrae, occurring in the same order.  Each vertebral is numbered so that doctors can keep track.

THE DISK’S ROLE: The disks are jelly-filled spongy shock absorbers between the vertebrae that cushion the spinal column as you move and are jarred.  (In the diagram, they’re the greyish, rounded objects between the vertebrae).  Among other purposes, they prevent the spine from crushing the ‘nerve roots’, which are the branches that come off the spinal column, out through the spine openings, and radiate out to various parts of the body.

HOW A DISK HERNIATES, OR ‘BULGES’: When a person suffers an impact or trauma, they can wrench or compress their back, causing the disk  (think shock absorber) to ‘squish’ outward or inward.  Since the outer surface of the disk is fibrous and tough, the disk can generally handle that and spring back.  However, sometimes the twisting or compression is so forceful that the disk’s outer fibers tear, and the inner ‘jelly’ escapes outward.  The disk will appear out of round and deformed, or ‘herniated’.  Depending on which physician you talk to, the terms ‘protruding disk’ and ‘herniating disk’ may be used alternately.

GETTING THE WHOLE PICTURE: The diagram shows a disc herniation at the space below the L5 vertebra.  You can see, in the right hand drawing, that the disk is protruding, or bulging outward.  In the cutaway view, (the middle picture on the right side) you can see that the disk has broken out of its round shape and is pushing forward.  Since the spine is closely ‘engineered’, there’s not a lot of room for this bulge, so that when the disk pushes out of its normal shape, or ‘herniates’, it can press on the nerve roots.  The results:  a distorted signal is sent back to the brain, resulting in the body experiencing pain, numbness, tingling or weakness in the area that the nerve root ‘feeds’ signals to.  (In the case of the L5 herniation shown here, the person experiencing the herniation would also tend to feel pain radiating down the back of their leg.  The side that experiences the herniation will likely experience the pain (a right sided herniation could produce pain or symptoms in the right leg; a left sided, the left leg).  With a lumbar herniation, this experience is often called ‘sciatica’, since the nerve that radiates out from this area is called the sciatic nerve.

This is an overly simplified explanation; there’s lots more that goes into diagnosing, assessing and treating spinal injury. The body’s natural degeneration over time, or spinal abnormalities which you’re born with but which don’t surface until you’re older, can also cause this phenomenon, for example, and many people walk around their whole lives with protruding disks that, because of their own particular anatomy, don’t trouble them at all.   But it’s a useful one, and I hope that it helps your understanding of what’s involved in a disk herniation, and how it can affect you.

Settlement Update: $900,000 in Benefits For Injured Worker When a Contractor ‘Covers Up” — The Case of the Deleted Defect

Torn Rotator Cuff

MALIS|LAW has obtained a stream of payments of over $700,000, along with waiver of a $210,000 workers’ compensation lien, for an electrician who injured her neck and shoulder after tripping over a floor hazard on a poorly lit construction site, even though the general contractor apparently attempted to ‘get rid of the evidence’ before it was observed by its own safety director.

AN ELECTRICIAN TRIPS AND IS HURT: My client was a 41 year old experienced female electrical worker assisting in the construction of a major addition to a Boston hospital.  While wiring an unfinished floor’s alarm system, she was walking with a spool of wire and tripped over bolt stubs protruding through the floor of a dimly lit corridor.  She fell forward into a pipe rack at the side of the hallway, injuring her left shoulder rotator cuff.  Within minutes of her fall, a crew of workers apparently descended on the accident scene, grinding the bolts level with the floor (leaving shiny patches on the concrete) and stringing new lighting in the hallway.  When the project safety director showed up at the accident scene, he observed a brightly lit corridor with orange paint splotches on the floor where the bolts had been.

THE INJURIES: My client suffered a torn rotator cuff immediately after the accident, which was surgically repaired.  The repair disclosed that the torn shoulder had obscured radiating neck pain into her shoulder caused by a disk herniation, which was surgically addressed by neck fusion.  We contended that she could no longer work in the construction trades, which required heavy exertion, which would cost her hundreds of thousands of dollars in future lost earnings from a highly paid and specialized trade.

OUR INVESTIGATION: Through two years of discovery and depositions, we were able to build a strong case that the general contractor and lighting contractor were negligent, including the following evidence:

  • My client presented a co-worker and independent witness who both verified the presence of the bolts before and after the accident.
  • Persistent document subpoenas and court orders produced ample records that the project lighting contractor had been criticized by the general contractor and its own inspectors for failure to replace burnt out project lighting promptly.
  • A safety audit conducted two weeks prior to my client’s fall harshly criticized the cleanliness of the project’s walkways, citing multiple trip hazards and trash.
  • A deposition of another worker disclosed that the bolts and poor lighting had caused another worker to trip days before, and that the worker had complained to the project’s safety director, who had failed either to note his complaint or to take action to remedy the hazard.
  • Although no one came forward to disclose the workers’  grinding of the floor bolts and new lighting, my client’s project supervisor verified the presence  four shiny ground down bolts in the floor within 40 minutes of the accident, in a pattern which suggested that the bolts had been used to secure an elevator hoist (the elevators had been fully installed weeks before).
  • The project safety director admitted that although he had investigated the accident scene, camera in hand, within 30 minutes of the accident, he failed to document conditions on the scene, although it was his and the general contractor’s policy that he do so.
  • The general contractor had written a letter to all subcontractors weeks prior to the accident detailing poor safety conditions and threatening to backcharge contractors for correcting them.
  • My client’s accident report was withheld for two weeks prior to disclosure to the project’s insurer, with no explanation of why the information was not immediately forwarded.

OUR STRATEGY: We used these facts to paint a picture of a poorly supervised and generally unsafe site, with the project owner and supervisors on notice of impending problems, and an embattled safety director new to the site and not up to speed.  These circumstances would lead a jury to infer that the accident was ‘covered up’ to avoid project controversy, supporting our claims of negligence.

PROVING DISABILITY: As to injury, the contractors and their insurers and attorneys contended that the Plaintiff’s injuries were largely healed and her complaints of pain were largely distorted.  An attempt to intimidate my client with a late-disclosed private investigation which purportedly showed that she was able to perform work was frustrated by a court order allowing the investigator’s deposition.  The investigator admitted (less than a week before a court-scheduled mediation) that he had not observed my client engaging in any substantial exertion, and that she had labored in picking up pieces of firewood that a delivery company had dropped in her driveway.

THE SETTLEMENT: At mediation, we were able to persuade my client’s workers’ compensation insurer to drop its right to be repaid $210,000 in compensation payments which my client had received, and to persuade the liability insurer to pay a stream of payments worth in total over $700,000 over a five year period.  These payments ennabled my client to retrain, and she now works for an electrical contractor in a supervisory position, without need for substantial exertion, at or near her prior pay level.

Trial Update: Five Years, Two Trials, An Appeal, A Victory — The Case of the Revised Report

THE JUDGMENT:  MALIS|LAW recently obtained a final judgment of over $80,000 against a major supermarket chain for a shopper injured on a wet floor, prevailing despite five years of questionable tactics and an attempt to ‘rewrite’ a favorable medical report by a defendant expert witness.

THE FACTS OF THE CASE: In this slip and fall case, the shopper slipped and fell on water coming out from under a green mat placed up against the base of a refrigeration case.  Claiming supermarket negligence, we contended that the store’s employees had placed the mat over the leaking area either to conceal or absorb the leak rather than repairing the refrigerator.   The supermarket chain asserted that there was no negligence and disputed the causation of the plaintiff’s fall and the extent of her injuries.

THE HERNIATED DISK: As a result of the fall my client sustained what was initially believed to be a back sprain. However, an MRI conducted by Shields MRI revealed a lumbar disc herniation which compressed the nerve root which carried signals to her leg, causing radiating leg pain. My client complained of ongoing back pain which has not resolved, aggravated by exertion,  and causing interrupted sleep. She was assigned a permanent loss of function of 10-15% of her whole person by her treating physician.

PROVING THE CASE: During discovery the store’s attorney initially refused to produce an incident report prepared by the defendant’s store manager, which he had  used to prepare the manager for deposition.  We immediately filed a  Motion to Compel Production which also sought sanctions, and the attorney, to avoid a court order, voluntarily produced the report.    The report revealed that the store manager had observed water from an unknown source on the floor where the plaintiff fell at the time of her injury.  Despite this disclosure, the defendant insisted that there was no water on the floor; that if there was water the defendant was not responsible; that any water was not present long enough for the defendant to have notice of it; that the water did not cause the plaintiff’s fall; and that the plaintiff had suffered no real injury.

THE ATTEMPTED REVISION: Shortly before trial the defendant presented as an expert  the owner and supervisor of the facility where the MRI which confirmed Plaintiff’s disk herniation was taken .  The owner was the employer of the  radiologist who read the film and produced the report.  The owner was produced to testify that there was no abnormality which had been caused by the fall shown on the plaintiff’s MRI.  At the same time, the store and its attorney produced a report which was supposedly an ‘addendum’ to the plaintiff’s MRI original results.  This report, allegedly issued by the plaintiff’s radiologist, contradicted his prior findings, indicating no focal disc herniation and indicating that the Plaintiff was suffering only from, essentially,  ‘degenerative changes’.  The store did not call the original examining radiologist to contradict his earlier findings.  Nevertheless, we were ready for this tactic at trial, as it had been deployed by this same Defendant in another previous case. Despite the store having requested mediation at the commencement of litigation, the store only offered $3,000 in settlement and refused to negotiate further, and the matter proceeded to trial.

UNPRESERVED EVIDENCE OF THE EVENT: The case was tried over the course of two years on non-consecutive days due to conflicts in the presiding judge’s trial schedule in the Boston Municipal Court. At trial, Plaintiff produced a witness who verified that she saw the Plaintiff immediately following the fall adjacent to a refrigerator case lying in a large puddle of water coming out from under a green mat. The defendant’s store manager testified that the floor was regularly cleaned every hour, and that the water indicated in his report was in a different location than where the plaintiff fell.  However, on cross examination, the manager admitted that he had absolutely no memory of the event; that the described location was within a few feet of where the Plaintiff alleged falling; that the store has a camera provided to document such situations; and that he had decided not to take a photo of the area where the plaintiff fell.  We argued that the reason that the manager didn’t take the photograph was because he didn’t want to prove that his store was negligent, thus deliberately failing to preserve evidence.

MEDICAL EXPERT TESTIMONY: As to the victim’s injury, her treating neurologist testified over two half days of court time concerning the Plaintiff’s disk herniation, opining that it was causally related to the slip and fall accident, insisting, in the face of many hours of cross examination, that the abnormality was not the result of congenital or degenerative factors.  The neurologist also rejected Defendant’s spurious claims that her back pain was caused by an earlier incident in which the Plaintiff complained of leg pain in an isolated incident lifting luggage years before, or from an earlier accident in which she injured her back, treated for a few months, and was discharged.

THE WRONGFUL REVISION: As to the ‘correction’ to the MRI from Shields, the neurologist rejected the ‘newer’ addendum, noting that he himself had observed the herniation in review of the Plaintiff’s actual MRI films. The neurologist also observed that the ordinary practice in providing such ‘addenda’ is to provide them to the treating doctor within 30-60 days of an initial report.  The ‘addendum’ in question was prepared more than two years after the initial report, and was never provided to him by Shields MRI. This supported our argument’s contention that the amended report was a contrivance that was created after the defendant’s hiring of the radiologist’s employer, the owner of the facility, as an expert in the case.

JUSTICE PREVAILS: The trial judge rejected the Defendant’s expert testimony, and  found for the plaintiff in the amount of $35,000, with significant accumulated interest, for a total judgment of $65,000.  The defendant appealed the finding to the District Court Appellate Division, and the appeal was denied.  Defense counsel then sought a de novo trial before a jury in the Superior Court. One month before the re-trial, the supermarket chain’s in-house attorney directly contacted me and agreed to pay my client the amount of  the judgment, with accumulated interest, which by then was $85,000.

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Daniel Malis uses this blog to publish answers to frequently asked questions, convey interesting news and make the occasional law-related rant. If you have any questions or want to contact Daniel Malis, please see the Contact page of the MALIS|LAW Website.