The legal concept of the “paper-thin” skull relates to the premise that a slight injury directed to a highly vulnerable body structure can have greater and more serious consequences than normal is true. The classic example given is that of the “paper-thin” skull where a modest blow to the head can lead to severe and permanent brain damage, or even death. We fully understand that “all men are not created equal” from the biologic standpoint. It is also the reason why entities such as worker’s compensation determinations which basically assume that all work injury, or insult, is being directed to a “normal” body is inherently flawed unless such associated issues are also taken into consideration.
With the advent of genomic testing it has now become possible to determine, prior to birth, various hereditary determined potential and real lifespan liabilities. From the medical-legal standpoint this information has the most practical value, at present, in the field of spine-related tribulations.
What then would be the typical result of a minor insult being directed to a congenitally abnormal , and thus more susceptible, structure such as a spine? What if the spine owner was born with a genomic spine disorder such as juvenile discogenic disease and has other associated congenital abnormalities? What if the individual is a cigarette smoker and isn’t aware that smokers have up to a 3-4x higher incidence of disc egeneration than non-smokers and that this is the reason that their extensive treatment has been of no help to them? What if the individual is in a occupation of being an over-the-road trucker where back problems represent an additional occupational hazard ?
The bottom line is the resulting objectively determined radiologic and neurologic situation and not subjective determinations. Being hit in the head with a basketball is something not usually considered to a significant injury but in the case of an 18 year old who has a “silent” brain aneurysm which then ruptures causing unconsciousness and death the objective devastating sequela are clearly evident
In legal circles the concept of a “Gillette Injury” has has become popular. This entity is defined a injury to a body part due to “repetitive microtrauma” being directed to a “normal” body part over time.Although valid in a small number of cases the “Gillette” phenomenon has become overused.
How much of the outcome from an injury is an individual responsible for? Clearly, one can not choose one’s patients but what they have been directed by their physicians to stop smoking, improve nutrition and exercise, discontinue unhealthy medications, and start a self-administered health maintenance programs and do not do this? Whose responsibility does it then become?