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Published byAnnice Shelton Modified over 7 years ago
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I have been thinking about going mountain biking . . .
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How to win Neurosurgical Personal Injury Cases
Presented by: Kevin Yoo, MD, FACS Kaye Elamparo, NP
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Do not fear pre-existing spinal conditions!
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Do not argue about pre-existing spinal conditions!
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Getting hurt is a fact of life!
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Whiplash
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Getting old is a Bitch!
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Can you tell the difference?!
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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
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CACI 3927 Aggravation of Preexisting Condition or Disability CACI 3928 Unusually Susceptible Plaintiff
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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
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When is the need for spinal surgery related to traumatic event?
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Conditions that are easily attributable to trauma!
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Cervical Herniated Discs
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Lumbar Herniated Disk
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Annular Tear Sign of trauma Can progress to a herniated disc
Can be painful
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Conditions that are not easily attributable to trauma!
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Spondylolisthesis
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Spinal Stenosis
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Degenerative Disc Disease
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Traumatic Brain Injury
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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
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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.
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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
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Chronic Traumatic Encephalopathy
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