1. I have been thinking about going mountain biking . . .

2. How to win Neurosurgical Personal Injury Cases
Presented by: Kevin Yoo, MD, FACS
Kaye Elamparo, NP

3. Do not fear pre-existing spinal conditions!

4. Do not argue about pre-existing spinal conditions!

5. Getting hurt is a fact of life!

6. Whiplash

7. Getting old is a Bitch!

8. Can you tell the difference?!

10. When should they have surgery?
After all conservative care
Three conditions for surgery
Positive radiographic findings
Pain correlates with films
Must want to proceed with surgery
Must have good policy

11. CACI 3927
Aggravation of Preexisting Condition or Disability
CACI 3928
Unusually Susceptible Plaintiff

12. Pre-existing conditions
Degenerative disc disease
Cervical/lumbar spinal stenosis
Facet hypertrophy
Ligamentum flavum hypertrophy
Lumbar spondylolisthesis
Cervical/lumbar bulging or herniated discs
Cervical/lumbar disc annular tear
Scolisosis/kyphosis
Compression fractures
Bone spurs or osteophytes
Diffuse idiopathic skeletal hyperostosis
Ankylosing hyperostosis
Previous back or neck injury

13. When is the need for spinal surgery related to traumatic event?

14. Conditions that are easily attributable to trauma!

15. Cervical Herniated Discs

16. Lumbar Herniated Disk

17. Annular Tear Sign of trauma Can progress to a herniated disc
Can be painful

18. Conditions that are not easily attributable to trauma!

19. Spondylolisthesis

20. Spinal Stenosis

21. Degenerative Disc Disease

22. Traumatic Brain Injury

24. Glasgow Coma Score Eye Verbal Motor Perfect Score 15
1 does not open eyes
2 opens eyes to pain
3 opens eyes to voice
4 spontaneously opens eyes
Verbal
1 no speech
2 incomprehensible noise
3 incomprehensible words
4 confused
5 normal
Motor
1 no movement
2 decorticate posturing
3 decerebrate posturing
4 withdraws to pain
5 moves spontaneously
6 moves purposefully
Perfect Score 15
Most PI patients will be 14
Even at 14 or 15, have TBI

25. Post Concussive Syndrome
Headaches
Dizziness
Fatigue
Irritability
Sleep Problems
Concentration Problems
Memory Problems
Problems tolerating stress/emotion/alcohol
Anxiety/Depression
Changes in personality
Apathy
Photophobia/Phonophobia
Etc.

26. MRI with Traumatic Brain Injury Protocol
Imaging Healthcare Specialists
ADVANCED NEUROIMAGING TECHNIQUES
DIFFUSION TENSOR IMAGING (DTI): Looks at fiber tracts
SUSCEPTIBILITY WEIGHTED IMAGING (SWI): Looks for microbleeds
MR SPECTROSCOPY (MRS): Looks for chemical composition of brain tissue

27. Chronic Traumatic Encephalopathy