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 disabling because he was born with intervertebral discs which were not as strong as normal discs.
S.R. was uniquely fortunate to have survived a traumatic injury which could very well have been fatal. Generally speaking those individuals with genomic disorders are at greater risk for disability or incapacitation than the “normal” population. If however, those individuals engage in preventive programs they usually come out ahead of those with normal spines who are smokers.
The challenge clearly relates to effectively using health care information and preventive measures to keep one’s spine healthy.
An important issue has to do with the basic concept of “injury” itself. Most episodes which are often considered “injuries” in the legal context are, in reality, minor episodes which readily respond to appropriate conservative (non-surgical) spine care. Legal concepts such as the “Gillette Injury” or the “Paper-Thin Skull” can easily cloud the issue of what a “injury” really is.
At this time there are no databases upon which to predict the risk factors in individuals with JDD or genomic disorders in regard to potential lifetime disabilities and incapacitation. One important reason for this is the frequent failure to recognize these entities. 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.
This patient’s 1998 his imaging report noted only a “herniated disc” and nothing more. He was thereby treated only as a “herniated disc” patient and no time spent in attempting to educate him as to the reasons as to why the disc herniated in the first place.
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.
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. Patients with genomic spine disorders can build an important spine reserve by making daily effort in a spine health maintenance program.