Abstract
Introduction A frequently asked medico-legal question is whether or not an accident or injury is responsible for the onset of nerve root pain. There is virtually no information available in the scientific literature, which answers this question.
Methods
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A search of the medical literature over the last 10 years was carried out. “Causes of disc protrusion” Medline
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I designed and carried out a questionnaire of Members of the Spine Society of Australia, The Australian and New Zealand Orthopaedic Associations, and The Neurosurgical Society of Australasia. Each was questioned about symptoms, their quality, continuity, and time to onset after an accident. Reasons, which might lead the practitioner to conclude that there was no association, were documented, as well as the percentage of discogenic nerve root pain not caused by accident or injury,
Results 48% stated that there must be a continuity of symptoms from the time of the accident to the onset of root pain. 35% accepted that a maximum gap of 48 hours could be accepted before the onset of nerve root symptoms for a causal association to exist. The remainder said that up to 3 months of continuous ipsilateral somatic limb symptoms would be sufficient for an association between the accident and injury. Responders varied widely in their answer to the question “what % of acute discogenic nerve root pain is not caused by an accident or injury?” Responses ranged from 10 to 90%. Mean 58 %
Discussion There is a modest consensus about the circumstantial association of an accident or injury and the onset of nerve root pain. There is wide disparity about the causation of acute discogenic nerve root pain, in general.
The abstracts were prepared by Professor Bruce McPhee. Correspondence should be addressed to him at Orthopaedics Division, The University of Queensland, Clinical Sciences Building, Royal Brisbane & Women’s Hospital, Herston, Qld, Australia
