I have been thinking about going mountain biking . . .

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Presentation transcript:

I have been thinking about going mountain biking . . .

How to win Neurosurgical Personal Injury Cases Presented by: Kevin Yoo, MD, FACS Kaye Elamparo, NP

Do not fear pre-existing spinal conditions!

Do not argue about pre-existing spinal conditions!

Getting hurt is a fact of life!

Whiplash

Getting old is a Bitch!

Can you tell the difference?!

When should they have surgery? After all conservative care Three conditions for surgery Positive radiographic findings Pain correlates with films Must want to proceed with surgery Must have good policy

CACI 3927 Aggravation of Preexisting Condition or Disability CACI 3928 Unusually Susceptible Plaintiff

Pre-existing conditions Degenerative disc disease Cervical/lumbar spinal stenosis Facet hypertrophy Ligamentum flavum hypertrophy Lumbar spondylolisthesis Cervical/lumbar bulging or herniated discs Cervical/lumbar disc annular tear Scolisosis/kyphosis Compression fractures Bone spurs or osteophytes Diffuse idiopathic skeletal hyperostosis Ankylosing hyperostosis Previous back or neck injury

When is the need for spinal surgery related to traumatic event?

Conditions that are easily attributable to trauma!

Cervical Herniated Discs

Lumbar Herniated Disk

Annular Tear Sign of trauma Can progress to a herniated disc Can be painful

Conditions that are not easily attributable to trauma!

Spondylolisthesis

Spinal Stenosis

Degenerative Disc Disease

Traumatic Brain Injury

Glasgow Coma Score Eye Verbal Motor Perfect Score 15 1 does not open eyes 2 opens eyes to pain 3 opens eyes to voice 4 spontaneously opens eyes Verbal 1 no speech 2 incomprehensible noise 3 incomprehensible words 4 confused 5 normal Motor 1 no movement 2 decorticate posturing 3 decerebrate posturing 4 withdraws to pain 5 moves spontaneously 6 moves purposefully Perfect Score 15 Most PI patients will be 14 Even at 14 or 15, have TBI

Post Concussive Syndrome Headaches Dizziness Fatigue Irritability Sleep Problems Concentration Problems Memory Problems Problems tolerating stress/emotion/alcohol Anxiety/Depression Changes in personality Apathy Photophobia/Phonophobia Etc.

MRI with Traumatic Brain Injury Protocol Imaging Healthcare Specialists ADVANCED NEUROIMAGING TECHNIQUES DIFFUSION TENSOR IMAGING (DTI): Looks at fiber tracts SUSCEPTIBILITY WEIGHTED IMAGING (SWI): Looks for microbleeds MR SPECTROSCOPY (MRS): Looks for chemical composition of brain tissue

Chronic Traumatic Encephalopathy