Stuff in the ‘spinal injuries’ Category

Rear-End Auto Crashes: Aggravation of a Pre-Existing Condition

In the last Blog, we considered the scenario in which a rear-end collision triggered spinal pain and disability because, through the natural aging process, as our spines develop degenerative disc disease (“DDD”), our spines become more susceptible to injury after an impact (read more about degenerative disc disease/DDD here).

spinal injuries from car accident In this Blog, we discuss a different scenario: you already have a pre-existing back condition that is well-managed and you are enjoying life, but suddenly a rear-end impact aggravates your back condition causing it to become unbearable. Do you have a personal injury case? Absolutely!

The attorneys at the law firm of Grazian & Volpe have handled hundreds of auto crash cases and understand the medicine and law dealing with the aggravation of pre-existing injuries. In this Blog, which is part of a series on spinal injuries caused by rear-end auto accidents, we shall use a typical case of an aggravation of a pre-existing injury and explain how such a case is handled.

Aggravation of Pre-Existing Condition

Take the case of a 50-year-old man who goes to his doctor complaining of low back pain, gets an MRI performed, and is diagnosed with a bulging disc. He has occasional pain and discomfort from his bulging disc, but he learns to manage it through physical exercise and maintaining his health to keep his disc from further deteriorating. In other words, he is doing nothing that would, of itself, aggravate, i.e. worsen, his bulging disc. Altogether, his condition is stable and requires neither medication nor surgery.

Enter a negligent 20-something-year-old driver who rear-ends the 50-year-old man at a stop sign while texting a friend. The man now complains of excruciating pain associated with the same bulging disc. His doctor orders another MRI, but the man’s disc appears the same: it hasn’t herniated. Nonetheless, the man still complains of experiencing more pain after the accident than before and he can sit for only half the time that he used to be able to. So, his doctor prescribes him prescription anti-inflammatories and physical therapy and advises he take off work to rest in bed. What happens now?

The Eggshell Plaintiff Rule

In Illinois personal injury law, there is what is called the “Eggshell Plaintiff” rule. The “Eggshell Plaintiff” rule basically means that the defendant, or negligent driver, must take the injured plaintiff as he or she is found. Basically, whatever state the injured plaintiff was in at the time of the accident—that is the state to which he should be returned by means of compensation.

In the case of our 50-year-old man, the law says that he should to be compensated for the aggravation or worsening or his bulging disc. Because the man cannot be physically returned to his pre-accident status, the law provides the monetary compensation for aggravating effect of the collision.

Proving Aggravation of a Pre-Existing Condition

Juries are notorious for having difficulty deciding cases that involve an aggravation of a pre-existing condition. Why? The trial attorney for the injured plaintiff may be inexperienced or unskilled in how to communicate your situation coherently, and there’s nothing worse for your case than a confused jury.

When presenting your case to the jury, your attorneys should strain to make the jury’s deliberations as easy as possible. This means lining up evidence that makes it easy for the jury to gauge the aggravation of your pre-existing injury and to put a value on your pain and suffering.

Every case is different, though, which is to say that the evidence needed or available to prove an aggravation of a pre-existing condition will be different in each case. Prior and post medical records are extremely important: the prior will establish your “baseline,” while the post will demonstrate what aggravation resulted from the accident. Employment records can also be helpful if they show a change in occupation or position that can be tied to the aggravation. An impartial “injury witness” also goes a long way to convincing a jury of the aggravation, particularly when this disinterested witness can attest to your health and activity before and after the accident. Finally, if you participated in hobbies or activities that you had to give up on account of the aggravation, this also is helpful evidence.

Cases involving the aggravation of a pre-existing condition are not the easiest to win. Insurance or defense attorneys know that a lot of discovery work must go into such cases, and oftentimes expert medical witnesses must be called. This tends to add up quickly, subtracts from your ultimate compensation, and discourages some personal injury attorneys from taking such cases.

Nevertheless, all cases are different and you should definitely seek a free consultation before dismissing the possibility of a lawsuit to recover for your aggravation. Only an experienced injury attorney can give you a sense of the strength of your case. Don’t wait: call attorney Kurt D. Lloyd of Grazian & Volpe today at 773.838.8100, or fill out our online form for a free consultation.

The above article was written by Kurt D. Lloyd of Grazian & Volpe. Kurt Lloyd has been practicing personal injury law in the Chicagoland area for over 30 years and has helped his clients win more than $355 million in jury verdicts and settlements from insurance companies and corporations. Kurt helps his injured clients regain their lives after injury. The information provided comes from his extensive legal and medical research and years of experience trying injury cases in courtrooms throughout Illinois.

Rear-End Auto Crashes: Traumatic Facet Joint Injuries

In a rear-end auto collision, spinal injuries of the neck and back often occur. A traumatic facet joint injury to the spine as a result of a rear-end auto crash is a common injury. Facet joint injuries are an “invisible” injury. A traumatic facet joint injury is usually not seen on X-rays and MRI imaging studies.

The attorneys at the law firm of Grazian & Volpe have handled hundreds of auto crash cases and understand the medicine related to a facet joint injury in the spine. In this Blog, which is part of a series on spinal injuries caused by auto accidents, we shall explain what a facet joint injury is, how a facet joint injury is diagnosed, and what is done to treat a facet joint injury.

Facet Joints

The facet joints help stabilize our spine, holding the spinal column in place and preventing excessive rotation (twisting) and flexion or extension (bending) of the spine.

Facet joints also prevent rotation of the vertebral column to a great degree. In addition, facet joints are necessary to prevent spondylolisthesis, which is forward slippage of one vertebra upon another. When this injury happens, the spinal canal gets compromised and there can be problems with pinching of the spinal cord.

Traumatic Injury to the Facet Joints

In an auto collision, the sudden impact can produce mechanical forces to the body that cause violent flexion-extension (“whiplash”) of the cervical spine or neck. See Image No. 1 below. This is also medically known as cervical acceleration-deceleration syndrome. This sudden force is transferred to the facet joints which attempt to maintain stability of the spinal vertebrae during whiplash by preventing the spine from excessively bending forward or backward. However, the facet joint can be abruptly injured by dislocation of the joint or from tearing or inflammation to the cartilage in the facet joint.

Image No. 1 Flexion-Extension X-Ray images

Image No. 1 Flexion-Extension X-Ray images

Signs and Symptoms of Facet Joint Injuries

  • Acute onset of neck, mid or low back or pain.
  • Palpable tenderness directly over the facet joints and reduced range of motion and muscle spasms.
  • In the neck, pain increases when extending backward and improves when flexing forward.
  • In the low back, pain can radiate or extend from the back to the buttocks; pain is present when standing but increases with sitting.
  • In the neck, the pain can radiate or extend from the neck onto the top of shoulders and upper shoulder blades.
  • The pain and restricted motion are recurrent and ongoing.

Diagnosis of Facet Joint Injuries

A CT-scan at the spinal level involved is the imaging study of choice for a clinically suspected facet joint injury. However, a CT-scan is only sensitive for diagnosis of damage to the facet joint fifty percent (50%) of the time.

The best diagnostic method for facet joint injuries is a medial branch block procedure. The medial branch nerves supply sensation and enervation to the facet joints. During a medial branch block procedure, an anesthetic is injected in the spine near the small medial nerves connected to a specific facet joint.¹

If the facet joint or joints targeted in the block procedure are causing the pain, then a patient will obtain relief from the medial branch nerve block; and if the facet joint is not causing the pain, then a patient will not obtain pain relief. This is what makes the procedure diagnostic for facet joint injuries. See Image No. 2 below.

Image No. 2 Medial Branch Block procedure. Needle injection of corticosteroid to nerve.

Image No. 2 Medial Branch Block procedure. Needle injection of corticosteroid to nerve.

Usually, a medial branch block is performed on two different dates, months apart, to confirm the diagnosis.

¹ Cohen SP, Moon JY, Brummett CM, White RL, Larkin TM. Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation. Regional Anesthesia and Pain Medicine. 2015;40(4):376-383.

Long Term Treatment of Facet Joint Injuries

A procedure known as radiofrequency ablation (“RFA”) is used to treat a facet joint injury and obtain long term relief. An RFA is a minimally invasive procedure that reorganizes and modulates the nerve fibers carrying pain signals to the brain. In a radiofrequency ablation procedure, also called a rhizotomy, a probe is placed in the spine under x-ray guidance, and heat wave energy is delivered to the affected nerves. The waves “ablate,” or burn, the nerves that are causing the pain, thereby stopping pain signals from traveling along the nerves to the brain.

If you have suffered from back or neck pain due to someone’s negligence, getting an accurate diagnosis of your injuries is crucial. It is important to be informed and to utilize qualified medical professionals and experienced personal injury lawyers to help you fully recover. Call attorney Kurt D. Lloyd at Grazian & Volpe today at 773.838.8100, or fill out our online form for a free consultation.

The above article was written by Kurt D. Lloyd of Grazian & Volpe. Kurt Lloyd has been practicing personal injury law in the Chicagoland area for over 30 years and has helped his clients win more than $355 million in jury verdicts and settlements from insurance companies and corporations. Kurt helps his injured clients regain their lives after injury. The information provided comes from his extensive legal and medical research and years of experience trying injury cases in courtrooms throughout Illinois.

Spinal Injuries in Auto Crashes: Herniated Disc Injuries

In rear-end auto crashes, spinal injuries of the neck and back often occur. A herniated disc of the spine from a rear-end auto crash is a common injury. But a herniated disc injury is usually not diagnosed by your physician for many months, despite ongoing pain, numbness and tingling in your neck, back, arms or legs.

The attorneys at the law firm of Grazian & Volpe have handled hundreds of auto crash cases and understand the medicine related to a herniated disc injury. In this Blog—the first in a series on spinal injuries caused by auto accidents—we shall explain what a herniated disc injury is and how a herniated disc injury is eventually diagnosed.

A new, acute herniated disc in the spine is usually not seen on imaging studies immediately after a rear-end auto collision. In fact, the diagnostic features of a herniated disc which are found on a magnetic resonance imaging study (“MRI”) actually take time to develop in the spine before the MRI will be positive.

This phenomenon holds true even though you may have symptoms consistent with a herniated disc injury in the hospital Emergency Department immediately after an auto collision. Indeed, in the Emergency Department immediately after the car crash, the X-rays of the neck or back are usually negative, even though an MRI study of spine turns out positive for an acute herniated disc several months later.

Our attorneys understand the biomechanical processes that cause a herniated disc. In a rear-end car crash, the mechanical forces acting on your body can result in an abnormal flexion-extension of your spine. When this happens, one of the spinal discs between two of your vertebra can become herniated, that is, the impact forced “disc material beyond the limits of the intervertebral disc space.”* Our spinal discs are made up of two parts: the outer, fibrous part known as the annulus or annular ring; and the inner part, which is a jelly-like nucleus that absorbs shocks to the spine. Think of your discs as if they were jelly donuts which act as the shock absorbers of your spine.

When a herniated disc occurs, what happens is that the mechanical forces from the rear-end car impact tear the annulus (the outer wall of the donut) and some of the jelly-like nucleus pushes or extrudes into vertebral space. The resulting disc protrusion often irritates a nearby spinal nerve causing signs and symptoms of numbness, tingling, discomfort and pain.

MRI showing herniated disc

MRI showing herniated disc.

The MRI study of the cervical, thoracic or lumbar spine performed at the right time can be the gold standard for diagnosing an acute herniated disc ninety-two percent (92%) of the time. An MRI study involves radio waves, a magnetic field and a computer to create image of the spine and surrounding tissues. Our attorneys know how to read and review MRI images from a legal point of view. If your attorney does not understand how an MRI is read and interpreted, then you can lose your case.

Winning your case starts and stops with understanding the MRI results; what demonstrates an acute disc injury versus a chronic disc disease. A bright signal or “lucency” found on the T2 weighted images of disc on the MRI study proves relative acuteness from a rear-end auto collision. In older patients who have suffered from a rear-end auto injury, the presence of this bright signal can prove a new disc injury which is superimposed over a naturally aging spine. What the defense attorneys and defense experts like to do is call it degenerative disc disease of the spinal discs and blame that as the cause of numbness, tingling, discomfort and pain after a car crash, even though you were asymptomatic for a disc injury before the impact.

That’s why you need a good attorney.

At Grazian & Volpe, our years of experience spine injuries have given us the knowledge and skills to help our clients win their cases and recover the money they need to get on with their lives. After an auto accident, if you have low back pain, neck pain, or numbness, tingling in your arms, hands, legs or feet then you may a herniated disc or other disc injury. Call us at 773.838.8100, email us at or fill out our online contact form for a free consultation. We can help you.

* Fardon, D., “Lumbar Disc Nomenclature: Version 2.0Recommendations of the Combined Task Forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology,” Spine: November 15, 2014 – Volume 39 – Issue 24 – p E1448-E1465.


Aluminum Baseball Bat Responsible for Wrongful Death of Player

Aluminum Baseball Bat Causes Brain Injuries Leading to Wrongful Death of 18 year old player:

For over 25 years in our Chicago and South Chicago personal injury and worker’s injury practice we have advocated for the victims of negligent and reckless accidents and Volpe was surprised to see that event the gentler All American past-time of baseball is not immune from these dangers. A recent Montana verdict affirmed by its Supreme Court found that the manufacturer of aluminum bats was liable for the death of American Legion pitcher. The player died from brain injuries when hit by a ball struck by a player using a Model CB-13 Louisville Slugger. The family of the pitcher filed a failure to warn lawsuit alleging that the aluminum bats increased the danger of personal injury and death because pitchers have less time to react due to the increased velocity of the batted ball. The manufacturer stated that only the batter, as the user of the bat, had standing to bring a failure-to-warn claim and that it did not have duty to “bystanders” such as pitchers and fielders. The Supreme Court disagreed stating that in the context of a baseball game “all of the players were users or consumers placed at risk by the increased exit speed caused by the (aluminum) bat. (The manufacturer ) is subject to all players in the game…for the physical harm caused by its bat’s increased exit speed.”

We are strong believers in laws and practices which prevent and mitigate the dangers to consumers and workers and are pleased to report on this latest verdict. Our condolences to the family of the victim and hopes that his death will serve to prevent other wrongful deaths.

Personal Injury-Taming the Workers’ Comp Lien

On October 14th, we wrote of the complexities involved in cases where a third party personal injury and workers’ compensation cause of action co-exist ( October 14, 2011). Personal injury attorneys need to be aware of the prevailing workers’ compensation statutes and whether it is necessary to obtain approval of the third party settlement by the workers’ comp insurer. Many a malpractice suit has been predicated upon this issue and caution is the best defense.

Personal injury lawyers should educate themselves and be savvy when negotiating the workers’ compensation liens. The philosophy at Grazian and Volpe is to ask for everything-all the time. In over 25 years of practice we have never ceased to be amazed at the savings you can achieve just by asking….and then asking….and asking.

As all small firm practitioners realize (and quite painfully) is the expense inherent in litigation. It has been our experience that workers’ compensation subrogation adjusters may often advance those expenses where they are contemplating that your suit may satisfy that lien. If you let them know you are willing to file and put in the work but unsure as to fronting all the expenses-they may be quite willing to advance the case expenses. Most workers’ compensation subrogation statutes require the lien holder to pay a proportionate share of the third party litigation expenses at resolution of the workers’ comp lien. If you can convince them that advancing the litigation expenses in advance of the resolution is advantageious to them-you may be surprised at the speed with which you receive their check!

On that same note, remember that the statutory workers’ comp lien can be waived or reduced and sometimes you can negotiate a reduction in the lien if you agree to a lesser compensation settlement on the condition that a complete waiver is issued on the proceeds of the third claim. Many adjusters will celebrate closing the claim for a lesser amount in the face of the time and uncertainty of a personal injury claim.

Finally, (for the purposes of this blog), personal injury attorneys should consider comparative fault in reducing the workers’ compensation lien.  If you personal injury suit involves comparative fault on the part of you client, many states may allow a reduction in the lien. In addition, the employer’s comparative fault may also serve to reduce the lien. Ask the adjusters or defense attorneyes to provide you with a letter outlining the estent of fault apportioned to each party and use the letter to bolster youir case for a lien reduction.

This article is certainly not an exhaustive discussion of the tactics available to negotiate a reduction in the workers’ compensation lien. Our practive combines both personal injury and workers’ compensation which has given us a view to both sides of the equation. The key is to realize that these liens can be negotiated or waived and to apply good business sense to assess your leverage- the subrogation carrier may have good reasons to settle for less or more quickly.

Please follow us on, LinkedIn and FaceBook for more articles and videos discussing current issues of personal injury and workers’ injury. We love to talk law so feel free to call our offices or submit a question to John Grazian the first Tuesday of every month on WCIU, You and Me in the Morning.


When You Have a Workers’ Compensation Claim and a Personal Injury Claim

The attorneys at Grazian and Volpe has dedicated their practice to both workers’ compensation and personal injury law for over 25 years. The coordination of these practices has allowed us to maximize settlement recoveries and negotiate minimum liens on all cases. Please join us at, Grazian and Volpe on Facebook and John Grazian on WCIU, You and Me in the Morning for more information on how you can assure maximum recovery whether you are a lawyer or client.

Personal injury attorneys and workers’ compensation lawyers should be aware of the potential pitfalls created by the existence of both causes of actions resulting from a single accident. Careful coordination of the workers’ compensation and third-party personal injury claims will often result in increased net recovery for the catastorphically injured client. Lawyers should have working knowledge of their states workers’ compensation subrogation law-althouth this area of law is primarily statutory and varies widely form state to state, the strategies for getting a workers’ comp carrier to reduce its lien are the same in most jurisdictions.

There is a growing state trend to terminate future workers’ comp benefits if the worker fails to obtain the employer’s consent to the third party settlement. Where the client will need lifetime medical treatment a lawyer needs to obtain the workers’ comp carrier’s consent and waiver of termination of future benefits before accepting the third-party settlement proceeds. While this situation is most prevalent when the third party has state minimum insurance limits-lawyers should be cognizant of this trend in all cases.

The Many Faces of Spinal Injuries

Spinal injuries are an often catastrophic result of accidents: motor vehicle accidents; truck accidents, bicycle accidents, pedestrian accidents, slip and fall accidents and; work accidents. It is important that victims of accidents and their personal injury attorneys are aware of the many types of brain injuries that may occur.  Accident victims need to seek immediate medical attention whenever an injury to the back or neck occurs.  As detailed below, not every spinal injury is immediately apparent. Delay in seeking medical treatment can result in an avoidable tragedy. I will spend the next few months, each Wednesday, detailing the cause and effects of each type of injury. Today’s blog is a general overview.

Spinal injuries include the following:

  1. Quadriplegia:  also know as “tetraplegia”.  Quadriplegia occurs when there is an injury to any of the seven (7) cervical vertebra above the first thoracic vertebrae.
  2. Paraplegia: is a form of paralysis of the lower portion of the human torso, from the waist down. It is different than quadriplegia, which is paralysis from the neck down.
  3. Herniated Disc and Bulging Disc: Herniated disc injuries are also know as “ruptured disc” and “bulging disc” injuries. These can be serious and life threatening back injuries, which are unfortunately quite common as a result of the g-forces involved in high or low speed motor vehicle accidents.
  4. Back Pain: Back pain is a sure sign that a accident victim has suffered a spinal cord injury of has a bulging or ruptured disc. Lower back pain is typically the locus of the pain.
  5. Facet Joint Syndrome and Chronic Pain: Facet joints connect the vertebrae in the spine. They allow twisting, bending and other movements and affect the range of movement as well as strength, flexibility and integrity. If they become inflamed due to a motor vehicle accident, arthritis can develop into chronic pain syndrome and cause lifetime pain and stiffness.
  6. Whiplash:  This is the most common injury that occurs in a motor vehicle accident. Whiplash is an injury that occurs when the head is hurled backwards and then forward. This is a “hyperextension” injury from being jerked forward and a “hyperflexion” injury form being jerked backwards. These injuries can not only included spinal damage but may also be responsible for traumatic and mild traumatic brain injury.

Please join me at and the Grazian and Volpe Facebook page for the next 5 Wednesdays where I will detail these spinal injuries discussing their causes and effects.