Medical Exhibits - Demonstrative Evidence Expert Blog - MediVisuals

By: Robert Shepherd MS, Certified Medical Illustrator, Vice President and Director of Eastern Region Operations, MediVisuals Incorporated

Individuals who develop new or suddenly worsening symptoms consistent with nerve root or spinal cord impingement following a traumatic event are sometimes diagnosed with “disc-osteophyte complexes”. The term “disc-osteophyte complex” generally refers to abnormal extension of intervertebral disc material that accompanies immediately adjacent osteophyte formation at the vertebral body margin (see the below figure). It is important to note (as shown in the illustrations) that the disc almost always extends further than the osteophytes into the neural foramen or spinal canal to irritate or impinge upon nerve roots or the spinal cord.

Occasionally, individuals who are evaluated shortly after a traumatic event are found to have disc-osteophyte complexes. Because a minimum of several weeks is required for osteophytes to form as a result of a traumatic event, defendant insurance companies may argue that the presence of osteophytes so soon after the traumatic event in question may prove that the plaintiff’s injuries preexisted the traumatic event. Since it is the disc pathology extending beyond the osteophytes that is the actual cause of the nerve root or spinal cord irritation and inflammation, the defense’s arguments are not valid. As shown in the illustrations below, the sequence of events that typically takes place in these cases is that the plaintiff had minimally symptomatic or asymptomatic disc osteophytes prior to the traumatic event in question. During the traumatic event, the disc sustains trauma that results in worsening of the disc pathology while the osteophyte portion of the osteophyte/disc complex remains essentially unchanged. This worsening of the disc pathology in turn results in new or increased irritation or impingement of the neural elements.

By: Robert Shepherd MS, Certified Medical Illustrator, Vice President and Director of Eastern Region Operations, MediVisuals Incorporated

A traumatic event causing injury to an intervertebral disc may also cause subtle injuries to the bones around the disc. During an extreme lateral flexion injury (shown in the image below), the edges of the bone are driven together, injuring both the disc and the bone. As the bone/disc junction heals, overgrowths referred to as osteophytes may form.

Osteophytes take weeks or months to develop following a traumatic event; therefore, any osteophytes that are present soon after a traumatic event are likely pre-existing.

The osteophytes themselves may compress the neural elements as in the illustration above; however, in most situations, the osteophytes are a part of an OSTEOPHYTE/DISC COMPLEX. This is when the osteophytes and disc extend beyond their normal limits and compress the neural elements (spinal cord, nerve roots). In cases where osteophytes may have pre-existed a traumatic event, worsening of the disc bulge could occur following the trauma, resulting in new or aggravated symptoms.

Sometimes disc and ligament injuries occur on the same side as the force of impact. Other times, they occur on the opposite side. Injuries to the disc on the same side as the force are the result of stretching and tearing forces. On the opposite side, compression forces result in tears and micro fractures of the tissues and bones. (see illustration below). Osteophytes and facet hypertrophy can also form following injuries to intervertebral discs and ligaments. Injuries to the discs and ligaments result in instability and excessive motion of the joints that, in turn, results in constant trauma to the bone/disc and ligament junctions. This ongoing trauma results in overgrowth of the bones as it continually cycles through episodes of healing and reinjury.