Ohio Personal Injury Blog by Cincinnati Accident Attorney Anthony Castelli

Archive for the ‘back disc injury’ Category

My Method For Proving Disk Back Pain Caused By Car Accident

Friday, February 15th, 2013

Herniated Disk Attorney

Herniated Disk

As an Ohio Car accident attorney I often help car accident injury victims with back pain get money from insurance companies. It is called justice. It gives me great satisfaction to help a harmed client get their life back together physically and financially. In order to do this it is critical to be able to prove that the injury ( in many cases a back or neck disk injury) was caused by the automobile crash.


Here’s The Methodology Developed Over the Last 30Years To Prove Your Auto Crash Back Injury

Educate myself about the medicine involved and how the medical specialists make their judgement

Ultimately a doctor that treats my client is going to have to give me an opinion that the disk injury was caused by the car collision in question. I have to immerse myself in the medicine regarding the kinds of disk injuries and the kinds of evidence doctors look at to see if it was caused by trauma or was there another cause, such as wear and tear or the natural aging process.

You need to know the difference between a bulging and herniated disc, as a bulge is more likely to be a common age related finding. ( Source Mayo Clinic ) Of interest is the illustration above (showing two vertebrae and one disk) calls it a bulging disk and I renamed it a herniated disk. Unfortunately many doctors use the terms interchangeably when they are two different entities. The bulge looks more like the disk appearing beyond the confines of the vertebrae in at least 180%. whereas a herniation also sometimes called a protrusion is more focal in size and shape.

In the illustration above the disk is pressing on the nerve in the low back. this normally will cause the nerve to be painful and as it goes down the leg the individual would feel pain down the leg.


The Patient History: Their Story Is Critical

What the patient says about how they were injured and what their pain was like is critical. If the pain went into the buttock or down the leg there is suspicion of nerve compression by a disk. Couple that with a history that there was no blow to the leg that could be causing the pain then the suspicion is that the disk has herniated and is pinching the nerve like our illustration.

When did the pain start in relation to the car accident or other traumatic event. If the pain started two weeks later in the back and two months later in the leg many doctors would not relate the disk injury to the car wreck. But if the injury in the back and the pain radiating down the leg was immediately or within a day or so of the event the evidence is stronger that the car collision caused the disk injury.

What was the past medical history of my client. Did they ever have back or leg pain before. If they did and it persisted the question becomes Was the disk problem already there? Was there any past medical treatment for back or leg pain? If the pain was years before and went away and did not come back that can be seen as an isolated strain or sprain and not a disk issue. So past history is critical.


What Do All the Medical Records Say

People have a tendency to forget as time goes on the pain they had if it was inconsequential. In a few cases some claimants get scared and lie. That kills a case and rightfully so because their credibility is compromised. So it is important to gather past medical records from family doctors as well as from any orthopedic doctors. If there is no indication of any back complaints then the case is stronger for the current trauma being the cause of the problem.

It is important of course to get all treating doctors’ records. You want to compare the history the client gave you to what gets in the records. Sometimes it gets recorded incorrectly. Then you must tell the doctor the correct history to see if that affects his opinion as to causation.


What Do the Clinical Tests and MRI and X-Rays Show

First a diagnosis of the problem has to be made. Is is a disk injury or is it a fracture of the vertebrae or is it arthritis. The correct diagnosis must first be made and then the cause of the diagnosed condition can be better clarified.

If the disk space has narrowed and there is some arthritis in the back on the vertebrae then that may lead to a conclusion that the herniation has been caused by degenerative age and/or wear and tear and not the trauma. Although degenerative effects can be aggravated and cause more severe pain. But if the vertebrae are clean and the disc height is normal and well hydrated then this leads to more of a traumatic event as being the cause. In a rare case you will have fluid and swelling seen around the disk. This is strong evidence of a disk injury caused by a car accident. But rarely is the fluid or edema ever seen on MRI.


How Old Is the Man or Woman That Was Injured

Medical evidence and most doctors agree that after a certain age in the 40-50 year old range, 40-50% of the population has a herniated disc. Many have no symptoms at all. So if it’s a younger person then it is more likely a traumatic event.


Is the Patient Believable

The truthfulness of the claimant is critical. If they claim they can not do certain things, and that the pain is intolerable yet they are on Facebook running a marathon then their whole case comes into question, even if the MRI shows a herniated disk. Also do they appear to be trying to get better? Are they going to therapy?  Are they following doctor’s orders?


What Does the Doctor Say and How Do They Say It

It is important that the doctor treating the patient has all the facts straight. Then when they write their report are they strong in their conviction that the car crash caused the herniated disc? Do they know the mechanism of injury? Was it a rear-end collision? Were the forces violent enough to show significant car damage? When did the pain start and where?


Was the Injury Causing Event Believable

If there was very little or no car damage it can be hard to persuade many people that the event caused the injury. Although many doctors will say the amount of car damage is not significant some doctors will.  Most jurors just do not accept a severe herniated disk can be caused from an accident where there is no car damage and the offending party says their foot slipped off the brake and they rolled into the car in front of them.


What Medical Literature Is Reliable and Helpful

If it comes down to a disagreement between the treating doctor and the doctor the insurance company hires it is important for me to buttress my case with helpful medical literature. All I need to do is have one of the doctors say the literature is reliable and I can use it to ask the insurance doctor if he agrees or disagrees with what is stated in the literature. This in effect gives me a written witness that supports my client that the disk was caused by the car accident. There is plenty of helpful literature out there. But for now I will keep that  to myself.


Recently I asked an orthopedic surgeon from Tampa Florida, Dr John Shim, if he would give us his thought process on how he determines if a disk injury was or was not caused by a car collision.  You may agree or disagree with Dr Shim, but his thought process is instructive. Click here to read his article.


By Anthony Castelli Attorney

Anthony Castelli has over 30 years experience in car accident claims and over 25 civil jury trials. He is rated preeminent by Martindale Hubbel and Superb by AVVO. He is also listed by Super Lawyers Magazine as an Ohio Super Lawyer in personal injury. He will discuss your case with you at no charge. Anthony will take your case only if he thinks he can put more money in your pocket than you could do by your self. So he limits his practice to serious injury.  Anthony practices throughout Ohio and will come to you if you can not get to him. His fee is contingent on recovering money on your behalf. He can be reached at 1-800-447-6549 or in Cincinnati locally at 513-621-2345.


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Is Hulk Hogan Right About Laser Spine Surgery These Cincinnati Doctors Are Against It

Sunday, January 27th, 2013

Laser spine surgery is touted by some doctor’s as the new savior for people with back problems. Hulk Hogan recently brought a lawsuit against the Laser Spine Institute in Tampa Florida for $50,000 million dollars in damages. Is Hulk (Terri Bolea ) crying wolf, or is this procedure just another medical money maker with no real relief.

A prominent medial group in Cincinnati, Ohio, the Mayfield Institute, appears to agree that laser spine surgery is not a recommended treatment for back injury.  ( Source ) Other sources also criticize this procedure. (Citations below)


What is Laser Spine Surgery

I went to the web site of the laser spine institute and there was some information explaining the procedure. Although there are many minimally invasive back surgeries done through a small tube  (endoscopic procedure) the distinguising fact in laser spine surgery is the use of a laser. Here is a description from the laser spine institute ( where Hogan was treated) of a discectomy with the use of a laser.

“When a percutaneous endoscopic laser discectomy is performed, the surgeon uses X-ray monitoring and fiber optics that display images on a monitor similar to a TV screen, allowing the surgeon to see what is compressing the nerve during the procedure and removing it with a laser, ensuring a much higher rate of success.”

“The laser, camera, suction, irrigation, and other surgical instruments are inserted through this translucent working tube. Once all the tools are in place, the surgeon uses a laser to vaporize the disc material, thus diminishing the pressure on the spinal cord and/or the spinal nerve.”

So the laser spine institute says they ensure a much higher success rate by using this procedure. Well then why does not the Mayfield Clinic in Cincinnati recommend this. Here’s what they have to say on their web site.


Q: Why don’t Mayfield Clinic spine surgeons perform or endorse laser spine surgery?



Spine Surgery

Minimally Invasive Spine Surgery


They state: “While lasers have been used in surgical procedures for more than 20 years , there is no scientifically proven benefit for spine disc removal by laser, as compared to more convetional spine surgery.

The approach used in laser spine surgery is the same as that used in conventional spine surgery. Both can be done with minimally invasive techniques (Figure 1), and both have similar recovery times. In addition, both involve a laminotomy or laminectomy to gain access to the disc. Once the disc is visualized with either a microscope or endoscope, it is removed. This is where the difference occurs: the laser vaporizes the disc with laser energy, and with conventional surgery it is surgically removed with surgical instruments (Figure 2).”


The Mayfield Institute sources the Cochrane Review as the source to check for objective summary of research. The Mayfield Institute states the following about their resource supporting the resaon they do not endorse Laser Surgery.


“According to the Cochrane Review, which is generally considered the definitive source for information summarizing complex medical scientific data, “Trials of automated percutaneous discectomy and laser discectomy suggest that clinical outcomes following treatment are at best fair and certainly worse than after microdiscectomy (conventional surgery).” Mayfield surgeons agree with this assessment and therefore do not endorse or recommend laser spine surgery for their patients.


Was Hulk Hogan Duped Into Laser Spine Surgery

Is Hulk Hogan crying wolf for money. I suspect not . There is enough support for  his allegations that there may be truth to them. This does not necessarily mean that he will win his case. Hulk was apparently talked into a series of laser spine surgeries at large medical costs that had no effect on his pain. Hulk later read where the doctor involved had a financial interest and these procedures were questionable.  Be very careful and investigate fully before you decide on laser surgery on your spine. After all where there’s smoke there is often fire.


Citations and Further resources:

  Is laser Spine Surgery bogus


 SURGICAL INTERVENTIONS FOR LUMBAR DISC PROLAPSE  byGibson and Waddell in the Cochrane library

by Anthony Castelli Attorney an Ohio personal injury lawyer with over 30 years experience seeking fair compensation for those injury victims hurt by the fault of another. For a free consultation for serious injury victims call 513-621-2345

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Cincinnati Injury Attorney On The Dangers of Epidural Steroid Injections

Wednesday, November 21st, 2012

As a injury lawyer in Cincinnati, Ohio following the meningitis outbreak I have learned that epidural steroid injections ESI are dangerous and may not even have any lasting benefit.  So that you do not think this is just another bodily harm lawyer spouting off I will offer medical reference.


Intraspinal steroids: history, efficacy, accidentality, and controversy

A review   by Nelson and Landua in the Journal of Neurology and Psychiatry 2001;70:433–443 attempted to answer these 5 questions:

1. Are intraspinal steroid therapies effective for back pain or radicular syndromes?

2. Do epidural injections remain confined to the epidural space ?

3. Are presently prescribed steroid formulations neurotoxic?

4. What are the risks of epidural steroid injection?

5. What information should be given to patients in obtaining informed consent for these procedures?


A picture of the spinal canal may help the lay person understand their answers.



Epidural Steroid Injection Danger


The epidural space is an anatomic structure that surrounds the dura mater within the spinal canal and extends to the brain itself.  

Above you can see the needle going into the epidural space. Immediately adjacent to the epidural space is the subarachnoid space. The significance is that if the needle inadvertantly injects the neurotoxic steroid into that area grave problems can result such as arachnoiditis. This is a painful and disabling injury.


Answers to the Five Questions About Epidural Steroid Injections

(1) Intraspinal steroid therapy is not effective therapy for back painor radicular syndromes because steroid formulations, placebos, and sham injections have similar outcomes.

(2) When injected, epidural medications may not remain confined to the epidural space and some inaccuracies of placement approach 40%.

(3) The additives of steroid formulations— polyethlen glcol. benzyl alchohol, and benzalkkonium chloride-can be neurotoxic when injected intrthecally. further research may disclose that the steroid formulations and mixtures themselves may be neurotoxic.

(4) Epidural steroid infusion may result in increased pain. there also may be serious complications of arachnoiditis, spinal infection, or permanent neurological deficits.

(5) Patients should be informed that there is no evidence that epidural steroid injections provide permanent relief of pain. Serious permanent complications to the spinal cord are rare but there is risk.


Additional Resources:

The Burton Report



by Anthony Castelli Attorney a personal injury lawyer in Cincinnati Ohio. Mr Castelli has handled hundreds of back injury claim settlements resulting from negligence of others. He offers a free conultation

Anthony Castelli Attorney

8170 Corporate Park Drive #220

Cincinnati, Ohio 45242





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Does Your Cincinnati Personal Injury Claim Involve Your Back – What Should You Do

Wednesday, July 11th, 2012

If you have sufferd a personal injury as a result of the fault of another and your back is your major injury you probably have questions. Not only are you concerned about getting fair compensation, but your primary concern is getting better. Money never makes up for impaired health.

Lumbar Herniated Disk

As a Cincinnati personal injury attorney I have dealt with numerous back injuries for my clients and have had to make sense of medical terminology. What would you understand if your doctor said, “you have a herniated disc causing myelopathy and lumbar spinal stenosis at L4-L5.” What if the doctor then said, “you need a decompressive diskectomy and fusion at L4-L5.”

I have blogged previously about the legal aspects and calculating value for a back injury, at my Cincinnati personal injury and Accident attorney blog but now I’m talking about the relationship between you and your doctor and understanding what is really wrong with you back. And as important what should be done to fix it.

I found a great resource for back injuries called Spine-Health .It gives you questions to ask your doctor before deciding to have surgery.

1. What type of surgery are you recommending? Why?

2.  What is the source of the pain that is being addressed?  How do you know this? (Exploratory back surgery is not done).

3.  Please explain the procedure – at a very high level/with some detail/in great detail. What are my non-surgical options?

4.  What is the natural course of my condition if it is not surgically addressed?

5. What would you recommend if this were your friend/wife/sister/daughter etc…?

6. How long will the surgery take?

7.  What are side effects, potential risks and complications?

8.  What is the recovery period?

9. Can you draw a picture of what is wrong?

10. Can you draw a picture of the surgery?

11. What will my function and pain be afterwards?

There are multiple modalities to treat a back injury. Here is a video of a low back Laminectomy from my friends at Medical legal art.

Lumbar Laminectomy


By Anthony Castelli Attorney

8170 Corproate Park

Cincinnati, Ohio 45242




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Car Accident Back Disc Injury Value Part V

Friday, May 27th, 2011

Adding Your Damages for Fair Compensation – Summing it Up -2 Big Mistakes

After reading parts I -IV of the blog series, What is my car accident disc back injury is worth , you should have a better sense of what goes into the detemination of the range of values your insurance settlement should be worth for your injury.

Hopefully you realize that if you have a significant injury you should not attempt to settle this on your own.
Although you may think you know what your case is worth the whole time you deal with the insurance company on your own they are trying to devalue not value your case. Furthermore you bring nothing to the table to put any pressure on the insurance company to make a fair offer. If you reject their offer are you going to file your own lawsuit. the results could be fatal.

In fact the three biggest mistakes I see are 1. Wanting to much for your injury, 2. Accepting too little for your injury, 3. Attempting to reolve your case on your own without the help of an experienced personal injury trial lawyer. Here is a video I did on the two critical mistakes personal injury victims make.

You are welcome to call a cincinnnati personal injury trial attorney Anthony Castelli for a Free No obligation injury claim audit at 1-800-447-6549

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What is My Car Accident Back Disc Injury Worth lV

Friday, May 27th, 2011

This is part 4 in a 5 part series on how to determine what you disc back injury car accident is worth for insurance settlement

4. Different Injuries the range of settlement and use of Calculator formula

Many people ask is there a settlement calculator used. Some insurance companies do use computer programs. But these are not necessarily accurate . In fact the insurance company may even try to give you an offer less that what their own computer says. But computers can not really predict with any certainty what a case is worth. This is an art rather than a science.

The adage you add up your medical bills and multiply by 3 and then add lost wages does not hold true. The range of settlement comes down to the nature and extent of your injury . In Cincinnati , Ohio my experience is that a back disc injury that cause $20,000 in medical bills and $10,000 in lost wages , a diskectomy and the ability to still work at your former job but with some back pain that is permanent should start at $100,000. In other jurisdictions this may be a $300,000.00 case.

You still have to go back to all the factors I listed and the case could range from $50,00 to $150,00. depending on the positive and negative factors. Attorney John Hochenfelder does an exceptional job documenting New York back injury cases. These cases are well above what can be expected in Cincinnati.

However don’t let the insurance company tell you that your case is worth little in Cincinnati. I have seen offers as low as $15,000 and the verdict ended up on the order of $80,000. Here is the video on the exact case I tried on a spine injury jury verdict in Cincinnati , Hamilton County Ohio.

You must objectively evaluate the case and decide the range of value and then strive to get at least the mid-range for settlement. If the insurance company low balls you trust your experienced personal injury trial attorney to guide you.

For a no obligation Free case audit of your disc back injury I welcome your call at 1-800-447-6549. Please do not delay or make critical mistakes that can forever lessen the fair value of the justice you deserve.

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