Why Get An MRI For Your Workers Comp?

Sep 24, 2009

So you are going to get a MRI to see if you have damage to the disc in your spine? Imagine taking a photograph of something that can move around a bit, but declaring the way you photographed it, is the way it always is.

You might ask for a “stand up” MRI. The theory is that when a patient is lying down, they do not have the typical weight pressure on their disc as if they were standing. You don’t get to lie down while doing most jobs. Your spine typically must support the head and upper torso in the real world.

The lack of typical weight during a MRI taken while one is lying down may create a likelihood that it will not show how the pressure from the upper spine typically effects the extent of the disc abnormality.

Remember, the disc is not a stable, immovable thing. It is not a bone, it is more like an oval, or doughnut shaped, inner tube used as a shock absorber. It is primarily made of water. When healthy, it is kind of like a grape; when it goes bad, it loses its watery content (dessication) and bounce function, becoming more like a raisin. Although the outer edge/wall (technically called annular fibrosis) is supposed to be firm, it can be “squashed” in such a way that it does not spring back to its optimum shape.

Undue sudden pressure (like when a person falls down, is whip-lashed in a car wreck, or even in typical exertion movement) can cause a squeezing of this doughnut in a way that one outer wall loses its normal height; it just extends outward like a bulge.

Excessive trauma and the passage of time can cause the outer wall to lose its encapsulating effect. When this happens, the inner portion of the shock absorber seeps or extends outward, causing additional problems. This inner area is less dense than its outer edge, like the pulp of an orange surrounded by its skin. When the outer layer fails to hold the inner “pulp” in, the nucleus is described as “herniated”, thus the term “herniated nucleus pulposis”.

When the abnormality protrudes out into the surrounding neural area, it sometimes causes inflammation, decreased mobility, and even impingement on the nerve root that can result in pain and loss of strength into the extremity usually serviced by the nerve. The impairment of the extremity may qualify for a workers compensation schedule award.

When a radiologist reads a MRI, he notes the prominence of the abnormalities and passes judgment on whether or not he thinks the condition is problematic. He will also often comment on the state of nearby structures. For example, irregular joint function can cause abnormal bone growth such as bone spurs (osteophytes) or the narrowing of canals in bone structure needed for nerve passageways (foraminal stenosis).

He will quite often refer to the abnormalities in your spine as degenerative. Beware of this term, it is often as generic as using the word disease to describe any medical problem. Accordingly, while the word “degenerative” might sound like a bad thing to you, to claims evaluators it is often dismissed as common.

Anyway, without making it too confusing, it has been my experience that different MRIs of the same patient can demonstrate different pictures of the problem. Additionally the pictures can be interpreted differently by different radiologists and other medical professionals. And, even if your MRI does not provide the “objective” evidence of injury, that doesn’t mean that a person doesn’t have a permanently injured disc.

You should know that any segmental instability can cause stretching and tearing of the innervated ligamentous layer of the outer annulus fibrosis. Even without escape of nuclear liquid (herniation of the disc’s nucleus pulposis) the condition can be very painful. Innervated means there’s nerves there, causing localized pain.

Radiating tears are mostly found in the posterior annulus (back wall of the disc) and are closely related to the presence of severe nuclear degeneration. Peripheral tears are most often associated with trauma, as opposed to biochemical degradation, and develop independently of nuclear degeneration.

Many people are not aware that some clinical tests have indicated that as many as 18 of 60 negative MRIs have positive findings in discography. Discography is more accurate than MRI for the detection of annular pathology; a normal MRI does not exclude significant changes in the peripheral structure of the intervertebral disc, which of course, can produce pain.

A wound to the outer wall of the disc has a limited healing potential and the persisting defect could provide a pathway for irritating nuclear fluid escape into your perineural tissue, resulting in persistent pain. Treatment to this type of injury to the disc usually comes in the form of percutaneous decompression. Because the injury is less likely to cause extremity impairment, it may not qualify for a workers compensation schedule award – even though it can be just as dehabilitating as an extremity impairment… and frustrating when not properly diagnosed and treated.

So make sure you get a good photograph, and ask for a detailed explanation of it by someone trained in its full interpretation! Good luck on your MRI.

– Brad Harris, Attorney

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