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Trauma and the
Patient with Juvenile
Discogenic Disease
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S.R. was a 37 year old farmer when was driving his pickup
truck, unseatbelted, along a freshly tarred road. His vehicle lost
traction, went off the road, and rolled over multiple times. S.R. was ejected from the
cab and landed on freshly ploughed soil where the pickup then rolled over
him. The pickup and the body impression in the soil (head depression
marked in red) are shown below. S.R.'s MRI showed a pattern classic
for Juvenile Discogenic Disease (JDD). By landing on a soft surface
S.R. was lucky to simply survive this experience. He came out
looking better than his pickup truck. His back problems, after the
accident, were more severe because he was born with intervertebral discs
which were not as strong as normal discs. Did this place him at
higher risk for continuing problems? Yes indeed.
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| It takes a anatomically and metabolically
"normal" spine to do well on a high gravity
planet. Congenital abnormalities of development represent
significant liabilities. The presence of a genomic
abnormality suggests that others
are present because of the "Zebra
Principle" (if you see only one more a typically present
because they travel in herds). The MRI image to the right
shows a classic case of JDD. The "Zebra" in this
case was a congenitally fused segment (red dot) where the disc did
not form prior to birth. If trauma were to be directed to
this spine this abnormality would represent a weak link and would be subject to
greater insult. |
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| In essence, those with genomic
abnormalities of development are at greater risk for disability or
incapacitation than the "normal" population. The challenge then relates to using this
information appropriately under different circumstances. If one does
not have a "normal" spine and is subject to repetitive stress
does this represent a example of the legalese concept of the "Gillette
Injury" or the "Paper-Thin Skull"? |
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At this time there are no databases upon which
to predict the risk factors in individuals with JDD in regard to
potential disability and incapacitation. One important
reason for the absence of this information is the ubiquitous
present lack of understanding among patients and physicians regarding
genomic disease. G. K., a 41 year old maintenance worker
injured his back lifting a manhole cover in 1998 and required a
surgical discectomy. In 1999, again while lifting a manhole
cover, he experienced the recurrent free-fragment disc herniation
shown in the image on the left. This patient was never
advised that he had an underlying genomic spine disorder, nor offered a health maintenance program
to avoid future impairment and surgery. |
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This patient's 1998 his imaging
report noted only a "herniated disc" and nothing more. He was
thereby treated only as a "herniated disc" with no time spent in
attempting to understand the reasons as to why the disc herniated in
the first place.
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A.M., is a 36 year old world-class athlete who
noted non-specific low back pain over a period of 4 years.
After competing in a 130 mile adventure racing event he developed
leg pain, numbness and weakness. |
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Prompt MRI evaluation
revealed JDD and a very large non-contained disc herniation at
L4-5 level (red dot). Clearly there had been a chronic
contained disc herniation which then extruded a very large
fragment. With additional disc herniation this patient could
have suffered permanent foot drop or cauda equina compression.
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| Both cases shown above had good surgical
management but in genomic spine disorders the surgery is the minor event. The major
event is making the right diagnosis to start
with so that the patient can be informed regarding the importance of
continuing preventive care. In this regard not smoking and a daily
self-administered health maintenance program with safe axial spine
distraction/ traction are the key elements to retaining
quality of life and avoiding additional surgery. The Burton
experience has shown that individuals who are so apprised and provided
with this information are typically able to maintain high-quality function
and even to continue as professional athletes. The amount of time
and effort invested in this is directly proportional to the quality of
continued function. In many ways this investment is similar to a
savings account. Most patients with underlying genomic spine
disorders who are symptomatic have
little reserve in their spine savings accounts. They build a
balance by making daily deposits through a spine health maintenance.
The larger the deposits the greater the potential expenditures being allowed
by mother nature. |
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