Imaging shows what is present in the spine now. It rarely shows when a finding began. Connecting a finding to a specific car accident depends on evidence outside the image: what earlier imaging showed, when symptoms started, whether the exam matches the finding, and how common that finding is in people who were never injured. A causation opinion built on those four holds up. One built on the image alone does not. That is the standard I apply to cases in Charlotte.
Start With How Common the Finding Is
Many spinal findings are present in people without symptoms. In 3,110 pain-free adults, lumbar disc degeneration ranged from 37% at age 20 to 96% at age 80, disc bulge from 30% to 84%, and disc protrusion from 29% to 43% (Brinjikji, AJNR 2015). In the neck, 87.6% of 1,211 healthy volunteers had disc bulging (Nakashima, Spine 2015). A finding that most people of the patient's age already have is weak evidence of a new injury.
Some findings carry more weight. In adults 50 or younger, disc extrusion, protrusion, bulge, Modic type 1 change, spondylolysis, and disc degeneration were all significantly more common in people with low back pain than without it. Annular fissures and spondylolisthesis were not (Brinjikji, AJNR 2015 meta-analysis).
The Words on the Report Do Not Assign Cause
The radiology committee behind the standard disc nomenclature wrote that its definitions are not intended to imply external causes such as trauma, a relationship to symptoms, or a need for treatment (Williams, AJNR 2014). Terms like protrusion, extrusion, and annular fissure describe shape. Reading cause into them, from either side, misstates what the radiologist reported.
Prior Imaging Is the Strongest Evidence
When films from before the crash exist, the question changes from "is this common?" to "did this change?" One retrospective case series of 41 patients with cervical X-rays before and after a collision found an average loss of about 8 degrees of C2-C7 lordosis after the crash (Haas, Diagnostics 2024). That series had no control group, and its authors include Chiropractic Biophysics NonProfit and PostureCo affiliations. The method it demonstrates, measuring the same thing the same way on films before and after, is stronger than any interpretation of a single post-crash image.
Timing and the Exam
Symptoms that begin after the collision, in a patient without prior complaints in that region, support a connection. Symptoms that predate it weaken one. A neurologic exam that matches the level of a finding supports a connection between that finding and the patient's symptoms. A disc extrusion at L5-S1 with weakness, reflex change, and numbness in the S1 distribution is a different case from the same extrusion with back pain only.
What a Causation Opinion Should Say
It should name the finding, state how common it is without injury, report what prior imaging showed or that none exists, give the timing of symptoms, and state whether the exam matches. It should say what is uncertain. An opinion that states more certainty than the evidence supports will be tested by someone who knows the same literature. How the law weighs aggravation of a pre-existing condition is a question for the attorney.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
How do doctors decide if a car accident caused a spinal finding?
They weigh how common the finding is in uninjured people, what prior imaging showed, when symptoms began, and whether the neurologic exam matches the finding.
Can an MRI show when a disc injury happened?
Usually not. Most disc findings cannot be dated from a single study. Prior imaging of the same level is the most direct evidence of change.
Are some MRI findings more likely to be related to pain?
Yes. In adults 50 or younger, disc extrusion, protrusion, bulge, Modic type 1 change, spondylolysis, and degeneration were associated with low back pain, while annular fissures and spondylolisthesis were not (Brinjikji, AJNR 2015 meta-analysis).
Does the term annular tear or extrusion prove trauma?
No. The standard definitions are not intended to imply trauma, a relationship to symptoms, or a need for treatment (Williams, AJNR 2014).
What does Dr. Justin Dick include in a causation opinion?
Dr. Justin Dick in Charlotte, NC names the finding, its prevalence without injury, what prior imaging showed, symptom timing, whether the exam matches, and what remains uncertain.
Where can I get a spinal injury causation review in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PMID 25430861. LinkEvidence tier: Systematic review
- Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. PMID 26359154. LinkEvidence tier: Systematic review and meta-analysis
- Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015;40(6):392-398. PMID 25584950. LinkEvidence tier: Cross-sectional study
- Williams AL, Murtagh FR, Rothman SLG, Sze GK. Lumbar disc nomenclature: version 2.0. AJNR Am J Neuroradiol. 2014;35(11):2029. LinkEvidence tier: Editorial by the ASSR/ASNR nomenclature committee (expert consensus)
- Haas JW, Oakley PA, Ferrantelli JR, Katz EA, Moustafa IM, Harrison DE. Abnormal static sagittal cervical curvatures following motor vehicle collisions: a retrospective case series of 41 patients before and after a crash exposure. Diagnostics (Basel). 2024;14(9):957. PMID 38732372. LinkEvidence tier: Retrospective case series; authors include CBP NonProfit and PostureCo affiliations
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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