SPINAL INJURIES FOLLOWING MOTOR VEHICLE ACCIDENTS

About the Author 

Dr. Moheimani is a Board Certified Practicing Surgeon in Southern California. He has had long-standing interest in the management and treatment of spinal disorders and spinal pain. He has held previous clinical teaching appointments at Loma Linda University and University of Southern California. He has served in the past as Chief of Orthopaedic Surgery for Kaiser Permanente. He is actively involved in the management of college and professional athletes as well as weekend warriors. All references cited in this article are available upon request from the author.

SPINAL INJURIES FOLLOWING MOTOR VEHICLE ACCIDENTS

Spine Surgery in Santa AnaIt is well-known that trauma, whether it be from a motor vehicle accident, a slip and fall incident, a sport injury or a work injury, can cause onset of neck and back pain requiring treatment. The severity of the injury and the need for subsequent treatment varies greatly with individuals. An extreme example is demonstrated in an article in the Spine Journal in November of 2009. A 31-year-old woman did have a history of prior disc problem at L5-S1 requiring treatment. However, shortly after a motor vehicle accident, she presented to the emergency room with loss of bowel and bladder control requiring emergency surgery. MRI following the vehicular accident demonstrated that the disc herniation had extruded with significant compression of the neural elements, leading to acute loss of bowel and bladder function. In this scenario where there is a preexisting MRI, there is little to dispute regarding the causation of the massive disc herniation following the vehicular accident requiring surgery. However, it is well-known that individuals will have disc herniations and may be asymptomatic. This is frequently used as an argument to avoid paying for treatment of someone who is injured.

It is known that in the adult population of those who do not have disabling lower back pain, the incidence of disc herniation and disc degeneration is between 28% to 85%. The percentage of abnormality increases with age. This will sometimes falsely lead individuals to argue that the disc herniation is not the source of pain as it may have been preexisting. However, scientific studies dispute this finding. A study by Paajnen showed that in 20-year-old military recruits, there were 57% incidence of MRI abnormalities in those with back pain and 35% incidence in those without. In another study, only 15% of asymptomatic individuals had disc herniations compared to a similar group of symptomatic individuals where they had 42% abnormality. In a surgical group, neural compromise was present in only 4% of asymptomatic subjects compared to 54% of symptomatic subjects. Therefore, one can conclude that although MRI may be abnormal in asymptomatic individuals, it is much more likely to be highly abnormal in individuals having symptoms. Neural compromise is much more commonly seen in individuals requiring interventional treatment such as epidural injections or surgery.

It is also sometimes argued by so-called experts that disc herniations must have preexisting disc degeneration. However, the article in the Bone & Joint Journal of August of 2013 disputes this finding, indicating that there is no scientific validity to the argument that the disc must have been degenerated before it could herniate. Therefore, previously, a normal disc can herniate and may not necessarily have preexisting disc degeneration according to this scientific study.

It is well-known that discs fail and herniate with axial compression or compression and torsion. This is the same mechanism that occurs in spinal fractures following motor vehicle accidents. The publication in May of 2013 on Accident Analysis and Prevention, in fact, indicates that with increase use of seatbelts and new airbag technologies, there has been a decrease in severe spinal fractures, but an actual overall increase in the total numbers of spinal fractures. Data shows that an axial load is transmitted from the pelvis into the seat pans of the front crashes causing these types of burst fractures and compression fractures. Forces great enough to cause spinal fractures can similarly lead to disc herniations or disc injuries with onset of pain and subsequent disability.

Scientific data shows that the impact does not have to be significant to cause a spinal injury.  The article on whiplash injury published in the Bone & Joint Journal on June 30, 2009, states that “it has been recognized that the disability from whiplash is associated less with tire skid marks or the degree of vehicle damage than the effect of differential velocity on the head and upper torso.” In fact, it points out that 90% of whiplash injuries occur with speeds less than 14 mph. Furthermore, it points to the fact that summary of literature on crash test on human subjects concluded that a velocity of 2.5 mph was sufficient to cause symptoms. A speed of 8.7 mph was required to cause actual damage to the vehicle. They observed neck pain in volunteers being involved in vehicular accidents at 5 mph only. They point to, not only symptoms of neck pain and stiffness, but also secondary effects including forgetfulness, post trauma disorder, and driving anxiety. Depressive symptoms can occur after six weeks. They also point to the argument proposed by defense advocates that the claimant’s symptoms will disappear once litigation has resolved.  However, they point to multiple studies in the literature that showed evidence to the contrary indicating ongoing symptoms well after the case is settled.

An article in Archives of Physical Medicine Rehabilitation from March of 2014 points to a study in Canada showing symptoms of individuals following a motor accident suffering from symptoms of a mild traumatic brain, including sleep disruption, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headaches, neck pain, and mid back pain. 75% were experiencing this after six weeks. Although the incident decreased over the course of the year, many continued to be symptomatic and were seeking continuation of treatment. They were going to multiple providers to treat their symptoms.  Another study points to the prevalence of worsening symptoms in older individuals being involved in motor vehicle accidents. In these older individuals, many times studies revealed disc degeneration and disc herniations, which are sometimes attributed to aging.  However, it is forgotten that these individuals are much more prone to injury and have lingering pain. In one study of 161 participants, 72% had moderate to severe pain initially in the emergency room. They demonstrated that a large number had continued loss of function and disability well after the accident.

In addition, it is noted that not all individuals react the same way following a disc injury. Why does an individual with a 2 to 3 mm disc herniation complain of severe back and radicular pain and yet someone with a 6 mm disc herniation does not have significant pain? We are now gaining greater understanding of biological issues that contribute to back pain. A study by Kang et. al published in the Spine journal reflects that individuals who had symptomatic disc herniations had increased levels of nitric oxide, prostaglandin E2, and interleukin-6. Therefore, it is being increasingly understood that there are chemical mediators of pain, which are not really measured on MRI scans or other studies. The textbook on interventional spine points to the following: “Mechanically compressive disc protrusions are not the only causes of radicular pain. For this reason, chemical markers from the disc have been implicated in the inflammatory response.” They point to higher concentrations of prostaglandin E2 being found in individuals with positive straight leg raising tests. They also point to the fact that matrix metalloproteinases, nitric oxide, IL-6, and prostaglandin E2 have been implicated in intervertebral disc protrusions.  This chemical reaction, which irritates nerves and causes pain, is released post accident.  The chemical reaction may be a good explanation as to why epidural injections, which reduce an inflammatory response, are highly successful. As we point out to patients, epidurals do not reduce the size of disc herniation, but, frequently, an individual may have complete resolution of his or her symptoms following the procedure.

In summary, the severity of pain and disability following vehicular accidents are frequently discounted by interested individuals using explanations by biomechanical engineers and recruited “expert” physicians. However, the scientific literature points otherwise. These so-called “experts” frequently point to the fact that many individuals who are pain-free also have disc herniation.  However, as I have pointed out, clearly, there is a much higher level of MRI abnormality in symptomatic individuals than non-symptomatic individuals.  We know that vehicular accidents can cause severe injuries, including fractures, dislocations, and paralysis. However, it is also known that even impacts at much lower speeds can cause onset of neck and lower back pain. This has been established in even volunteer test individuals. As I have discussed, studies demonstrate that the extent of vehicular damage does not always explain the severity of neck and back pain. Multiple studies also point to the fact that individuals have ongoing chronic pain and disability more commonly seen in older individuals and this disability persists well after their case is settled. We are also now gaining further insight into the biological basis of spinal pain and know that a disc when injured can cause release of irritating chemicals from the disc, which cause pain and disability. These chemicals are not noted on MRI scans or physical examinations performed by independent medical examiners. Levels of these chemicals have been noted to be elevated in individuals having pain and radiculopathy. However, the understanding of the chemical mediators of pain has caused us to develop new technologies, advancing from epidural steroid injections to platelet rich plasma injections and stem cell therapy. There is emerging hope to treat the pain and disability of these individuals suffering consequences of vehicular accidents and other types of spinal injuries.

Orthopedic Surgery

Coast Spine and Sports Medicine provides you with comprehensive management of disorders of the spine — from initial evaluation through rehabilitation, pain management, and surgical treatment, when necessary.

When you suffer from a complex orthopedic injury or condition, you only want the most experienced and trusted professionals to oversee your care and treatment.
Dr. A. Michael Moheimani, Medical Director of Coast Spine and Sports Medicine

Dr. A. Michael Moheimani

Dr. A. Michael Moheimani

That’s why more Southern Californians trust Coast Spine and Sports Medicine. Founder and medical director Dr. A. Michael Moheimani, MD, has more than 25 years of experience as a board-certified orthopedic surgeon in Orange County, treating the widest array of ailments and conditions, but with particular emphasis on those that afflict the spine.

Dr. Moheimani is an accomplished surgeon — in fact, patients travel from across the globe for his care — but he is also well known to search for and use non-surgical or minimally invasive methods of treatment whenever possible.

Because of this, Dr. Moheimani has an impressive record in the treatment of many painful orthopedic conditions, including:

Degenerative disc disease
Spinal deformity
Spondylolisthesis
Osteoarthritis
Bone cancer and related tumors
Spinal fractures and trauma
Herniated discs
Spinal stenosis
Chronic neck and back pain
Acute spinal injuries
Sports-related spinal injuries
Repair of failed surgeries
and much more…

Dr. Moheimani is well known as a personable and friendly physician — the type of practitioner who spends his time with patients, so that they are fully informed of the facts of their case. You can count on Dr. Moheimani to thoroughly and accurately diagnose your condition, recommend and explain in detail the most effective treatment options, provide expert, state-of-the-art surgical interventions when needed, and guide every phase of your recovery and rehabilitation. Pain management in Orange County is our number one priority.

For all these reasons and more, it’s clear why Dr. A. Michael Moheimani is well known as the spine surgeon who cares.

If you are seeking an alternative treatment strategy, or if you have recently been diagnosed with a condition that requires orthopedic surgical response, consider making an appointment today with Coast Spine and Sports Medicine and Dr. Moheimani.

Simply complete the form on this page, and our caring staff will be in touch with you within one business day.

Or, call us at 714-285-0014 between 9AM-5PM Monday-Friday, and we will work with you to find an appointment time that is best suited for you.
Thank you for your interest in the orthopedic surgery capabilities of Dr. A. Michael Moheimani and Coast Spine and Sports Medicine of Santa Ana. We look forward to hearing from you and discussing the facts of your case with you in person.

Are You Suffering from Facet Joint Syndrome?

The adult human spine is made up of 33 bones, or vertebrae. Facet joints connect the vertebrae, and provide for the stability and flexibility of the spine. There are two facet joints between each pair of vertebrae, one on each side. Facet joints link each vertebra to those directly above and below it, and allow the vertebral bodies to rotate with respect to each other. Cartilage in the joints allows for smooth movement where vertebral bones meet, and each is lined with a thin membrane called the synovium, which produces synovial fluid for lubrication. Sometimes, facet joints may become inflamed, irritated or swollen, causing pain and other uncomfortable symptoms due to the impingement, or “pinching” of the nerves that serve the facet joint. This is called facet joint syndrome. Potential causes of the condition include inflammation, infection and degeneration of the vertebrae and the discs that cushion and protect them due to aging, trauma and/or poor posture.

Here are two ways to tell if you have facet joint syndrome:

  • If the affected joint is in the neck, or cervical spine, it may cause localized and/or radiating neck pain and headaches, and it also may be very difficult to turn your head.
  • If the affected joint is in the lower back, or lumbar spine, it may cause back pain, pain that radiates into the buttocks and legs, and it may become difficult for you to walk or stand.

If you think you are suffering from facet joint syndrome, there are several ways to diagnose and treat it. Please contact us at 888-866-1660 to schedule a consultation.Follow us on social media:

Jan 17 Coast Spine & Sports Medicine New Spinal Cord Stimulation Treatment HF10

Orthopedic Surgery Los AngelesIf you suffer from back pain, you are not alone. Back pain is the most common reason for physician visits in the United States. Living with severe pain can not only interfere with your quality of life, it can interfere with your ability to work and enjoy time doing the physical activities you love the most. Spinal cord stimulation is a proven therapy that offers a treatment option for chronic pain. It is most commonly used to treat low back and leg pain. Spinal cord stimulation uses electrical pulses to interrupt pain signals, resulting in pain relief. Many people with chronic low back and leg pain have received relief with spinal cord stimulation. A common side effect of spinal cord stimulation is tingling or buzzing sensation known as paresthesia. Coast Spine & Sports Medicine now provides HF10 therapy for spinal cord stimulation which does not cause paresthesia and allows the patient to focus solely on pain relief. To learn more about HF10 therapy or schedule a consultation, please contact 888-826-1660.Follow us on social media:

Alpha-2-Macroglobulin: A Preventive Treatment for Arthritis

Arthritis Treatment Los AngelesArthritis is a debilitating chronic pain condition that affects millions of baby boomers around the world. Research shows that the progression of osteoarthritis may be prevented with alpha-2-macroglobulin. What is A-2-M? Alpha-2-macroglobulin protein found in your own blood that prevents the breakdown of the cartilage which leads to further progression of arthritis. In an osteoarthritic joint it is not able to counteract the further breakdown of the tissue. Coast Spine & Sports Medicine directly injects A2M into your arthritic joint. It is expected to be the first treatment for osteoarthritis that can inhibit all causes of cartilage breakdown, reduce pain, and stop the progression of arthritis. To learn more about A2M or schedule a consultation, please contact 888-826-1660.Follow us on social media:

Jan 10 Can Degenerative Disc Disease Be Treated With PRP?

Degenerative Disc Disease Treatment Los AngelesAlthough it is a normal part of the aging process, degenerative disc disease can cause painful symptoms. Fortunately, there are minimally invasive treatment options that help provide relief and keep you active.

Degenerative disc disease (DDD) is part of the natural process of growing older. As we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The outer fibers that surround the disc, called the annulus fibrosis, become brittle and are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. The combination of damage to the intervertebral discs, the development of bone spurs and the gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the lumbar spine.

To a certain degree, this process happens to everyone. However, not everyone who has degenerative changes in their lumbar spine has pain. Many people who have “normal” backs have MRIs that show disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.

What Are The Symptoms Of Degenerative Disc Disease?

When degenerative disc disease becomes painful or symptomatic, it can cause several different symptoms due to the compression of the nerve roots. Depending on where your degenerative disc is located, it could cause:

  • Back pain
  • Radiating leg pain
  • Neck pain
  • Radiating arm pain

These symptoms are caused by the fact that worn out discs are a source of pain because they do not function as well as they once did, and as they shrink, the space available for the nerve roots also shrinks. As the discs between the intervertebral bodies start to wear out, the entire lumbar spine becomes less flexible. The result can be back pain and stiffness, especially towards the end of the day.

How Is Degenerative Disc Disease Diagnosed?

The diagnosis of degenerative disc disease begins with a complete physical examination. Your doctor will examine your back for flexibility, range of motion, and the presence of certain signs that suggest your nerve roots are being affected by degenerative changes in your back. This often involves testing the strength of your muscles and your reflexes to make sure that they are still working normally. You will often be asked to fill out a diagram that asks you where your symptoms of pain, numbness, tingling and weakness are occurring.

A series of x-rays is also usually ordered for a patient with back pain. If degenerative disc disease is present, the x-rays will often show a narrowing of the spaces between the vertebral bodies, which indicates the disc has become very thin or has collapsed. Bone spurs also can form around the edges of the vertebral bodies and also around the edges of the facet joints in the spine. These bone spurs can be seen on an x-ray, and are also called osteophytes. As the disc collapses and bone spurs form, the space available for the nerve roots starts to shrink. The nerve roots exit the spinal canal through a bony tunnel called the neural foramen, and it is at this point that the nerve roots are especially vulnerable to compression.

In many situations, doctors will order a MRI or a CT scan (CAT scan) to evaluate the degenerative changes in the lumbar spine more completely. A MRI is very useful for determining where disc herniations have occurred and where the nerve roots are being compressed. A CT scan is often used to evaluate the bony anatomy in the spine, which can show how much space is available for the nerve roots and within the neural foramina and spinal canal.

How Is Degenerative Disc Disease Treated?

Your doctor will discuss with you the treatment options appropriate for your diagnosis.

For most people who do not have evidence of nerve root compression with muscle weakness, conservative, non-surgical therapies, such as medication, rest, exercise and physical therapy, are typically recommended.

While PRP and Stem Cell therapy are not currently indicated for the treatment of any condition, studies show it is certainly a promising alternative to surgery. Surgery is offered only after conservative treatment has have failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period of time.

The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.

Does Rain Really Cause Pain?

Pain Management in Los Angeles

Today is a rainy day in Southern California, and you may have noticed a few extra aches and pains or arthritis or low back pain flare ups. We have all seen it, someone with osteoarthritis or lower back pain complains about flare ups on cold rainy days. But why does this phenomenon happen?Why does rain cause pain?

There is one theory that the lowering barometric pressure allows tissue to expand. Pair this with existing nerve sensitivity, scar tissue, adhesion or other injury and you have a recipe for increased pain in any area which already experiences pain.

Dr. Moheimani of Coast Spine & Sports Medicine shared that while there is no “quick-fix” to rainy day aches and pains, PRP & Stem cell therapy is a wonderful regenerative solution to heal the damaged tissue. For more information about PRP & Stem Cell treatment, contact us at (866)826-1660.

Sciatica Specialist Dr. Moheimani Provides PRP Treatment

Sciatica Treatment Los AngelesAccording to Spine-Health, sciatica is a term that describes symptoms of pain, numbness, and/or weakness that radiate along the sciatic nerve from the lower back to the buttocks and leg. The medical term for sciatica is lumbar radiculopathy.

The vast majority of sciatica symptoms result from lower back disorders between the L4 and S1 levels that put pressure on or cause irritation to a lumbar nerve root.

Most commonly, sciatica is caused by a disc problem, such as a herniated disc that is pressing against a nerve root.

It can also occur when a disc degenerates, which releases inflammatory proteins that irritate the adjacent nerve. There are many additional causes of sciatica.

Sciatica symptoms are typically felt on only one side of the body. They may include a combination of leg and foot pain, weakness, tingling or numbness.

Sciatica pain is often described as searing or sharp, as opposed to achy or throbbing.

Depending on where the sciatic nerve roots are compressed, symptoms may be felt in different areas of the leg and into the foot.

At Coast Spine & Sports Dr. Michael Moheimani treats sciatica among several other degenerative disc issues. Don’t suffer in pain, contact us at (888)866-1660 today to schedule an appointment.

Seniors Suffering from Arthritis in Orange County, CA

Arthritis Treatment Los AngelesWe can now provide seniors with PRP and stem cell injections into the spine and extremities, saving them the painful necessity for surgical intervention.

What is PRP? PRP stands for platelet rich plasma. Platelet rich plasma is a concentration of platelets that contains regenerative healing factors. Studies show that an injections to damaged tissue heals the tissue by causing new tissue to grow. Seniors suffering from osteoarthritis is an excellent candidate for PRP injection. The normal wear and tear of joints that happens with aging is greatly improved by a single injection to the area.

Please contact us at (714)248-0014 to schedule a consultation.

Laker’s D’Angelo Russell Receives PRP Injection to His Knee

PRP & Stem Cell Therapy in Los AngelesLakers point guard D’Angelo Russell will miss 2 weeks after receiving a platelet rich plasma injection to his knee. USA Today reports that Russell has missed two of the Laker’s last three games with soreness in his left knee, but the second year point guard had thought it wasn’t a serious injury.

Russell is one of several athletes to join Kobe Bryant, Tiger Woods, and Stephen Curry to choose PRP over cortisone injections. Platelet rich plasma, or PRP, is a concentrated form of of growth factors and cell mediators that have been shown to greatly promote the repair of damaged tissues. The knees might become damaged due to trauma, such as a car accident or sports injury. The knee joint may also break down over time due to a chronic condition called osteoarthritis. The breakdown of the knee tissue will eventually lead to pain, joint stiffness, and sometimes swelling.

Cortisone is a corticosteroid, it is not a natural drug and relief is temporary. PRP, or platelet rich plasma, is 100% natural and developed from the patient’s own blood.
PRP heals the wound not studies indicate that platelet rich plasma has a healing effect on the body by regenerating the damaged tissue in a much shorter down time.
PRP can be injected into the spine as well as the extremities. PRP injections into the knee were a choice both Kobe Bryant and Stephen Curry made to get back in the game. While Stephen Curry was expected to be out for two weeks, after receiving PRP he made it back into game 3 of the playoffs.

Orthopedic Surgeon and Spine Specialist Dr. Michael Moheimani has a solution for knee pain with a natural non surgical approach to medicine through platelet rich plasma injections to the spine, reducing the need for invasive surgery, the need for opioid use, and avoiding potential misuse.