Car accidents can happen in so may different ways – head-on collisions, T-bone collisions, rear-end collisions, and sideswipes are all common. Rollovers or pole impacts can also occur. Each type of car accident puts different forces on the human body. For that reason, the types of injuries that we see vary quite a bit. However, there are some types of injuries that are most common.
Neck, Back, or Spine Injuries in Car Accidents
The single most common injury from a car accident involves injury to the neck, back, or spine. The forces from the collision cause the spine to bend rapidly in one direction, and then often just as rapidly in the exact opposite direction. This back-and-forth can damage the spine in a couple different ways.
To understand spinal injuries, we have to first understand the basic structure of the spine. Our necks, backs, and spines consist of bony blocks called vertebrae that are stacked on top of each other, all the way from our tailbones to the bottom of our skulls. Those bony blocks are separated by softer discs, sometimes called “intervertebral discs,” that keep one bony vertebra from scraping against the vertebrae above and below it. These discs allow our necks, backs, and spines to bend or flex without pain.
In a severe car accident, one of the vertebrae can break or fracture. Sometimes the fracture is small, and doctors may call it a “stress fracture.” Other times, a piece of a vertebra can chip away or break off. Fractures like that are painful, and the damage is usually permanent. In some severe car accidents like rollovers, a vertebra may be subjected to such force that it shatters. Doctors call that a “burst fracture.” Neck or back injuries like this are very dangerous because if the bone cuts the nerves that run up and down the spine (often called the “spinal cord”), then the victim of the car accident can be permanently paralyzed.
More commonly, car accidents cause injuries to the discs between the vertebrae in the neck, back, or spine. To put it in common terms, the discs get squished. Sometimes they don’t handle that well. The discs contain fluid inside them, and sometimes the fluid has no place to go when the disc gets squished, so it presses against the disc’s outer wall. If the outer wall partially gives way, then the disc may begin to press against the nerves that run up and down the spine. That hurts. Doctors call that a bulging disc, disc herniation, or herniated disc. The rest of us may call it a “slipped disc.” A car accident can also cause a disc to become flattened or narrowed, or the car accident may make pre-existing damage to the disc worse.
Car accidents can also cause the discs to rupture. Doctors may call this injury an “annular tear,” and it is very painful. If a car accident causes an annular tear, that means that the disc has essentially ripped open and is leaking fluid into the spinal canal or elsewhere. That’s difficult for doctors to repair. It hurts for two reasons. First, the disc is no longer able to keep the vertebrae above and below it separate, and the pressure between those vertebrae causes pain. Second, the leaking fluid can intrude into the canal that contains the nerves that run up and down the spine. When the fluid starts to fill up the spinal canal, it puts pressure on those nerves. That hurts too.
Because the nerves that run up and down the spine go to every part of the body, it is sometimes not clear where the pain from a car accident is coming from. For example, if a herniated disc is putting pressure on a nerve that runs down a person’s leg, the car accident victim may feel pain that shoots down that leg, even though the injury is really to the disc in the spine. Neck, back, or spinal injures can therefore cause pain that feels like it comes from a foot, leg, hand, or arm. When pain from a car accident moves around like that, doctors say the pain “radiates,” and they may diagnose radiculopathy.
Treatment for Neck, Back, or Spinal Injuries
Car accidents so often cause injuries to the discs in our necks, backs, and spines that the medical treatment for them is somewhat predictable. At the emergency room or the first doctor that a client sees after a car accident, they are often given naproxen, ibuprofen, or another mild pain reducer in connection with a muscle relaxer. If the pain continues, the next step is usually physical therapy or a chiropractor. Doctors refer to this phase of treatment for car accident injuries as “conservative treatment.”
If the pain continues further, there is a wider range of options for doctors and victims of car accidents to explore. They may try epidural steroidal injections, or ESIs. Injections like this usually help the pain from the car accident for a few days or weeks, but whether the relief lasts longer than that varies from patient to patient. Most doctors won’t perform injections on a given place more than three times because continued injections can be harmful to the body in other ways. Doctors may also suggest radiofrequency ablations, or burning the nerves, to relive pain from a car accident.
If none of that works, doctors often suggest surgery to treat the car accident injuries. The type of surgeries available varies widely, but one of the more common is a spinal fusion. A spinal fusion involves placing a metal plate or other device between or on top of two vertebrae and inserting bone screws to keep the plate or device in place. The fusion essentially immobilizes the vertebrae so that they cannot move any more. The goal is to relieve pressure on the disc that was damaged in the car accident. Spinal fusions often work well to lessen persistent pain, but they are not perfect. In the long term, arthritis around the surgical site is common, and the discs above and below the fusion tend to wear out faster. When they do, additional medical intervention may be necessary.
Another common type of surgery after a car accident is a laminotomy, which removes part of the lamina in an attempt to make more room for the nerves in the spinal cord. A foraminotomy has a similar goal, and involves cutting away a different part of the spine called a foramen. Discectomy surgeries involve cutting away the part of a disc that is intruding into the spinal canal. Laminotomies, foraminotomies, and discectomies are all common following car accidents.
Concussions and Traumatic Brain Injuries from Car Accidents
Car accidents can cause concussions and other traumatic brain injuries in a couple of different ways. Most obviously, a person’s head can get slammed into something, often the steering wheel or B-post (the part of the car that supports the roof between the driver’s and left-rear passenger’s windows). If a person’s head strikes a hard surface like that, then the concussion or traumatic brain injury is easy to diagnose.
Most concussions or traumatic brain injuries in car accidents don’t leave such obvious external signs, however. When a person’s head is moved rapidly back and forth in the car accident or bangs against the soft headrest, the brain can suffer injuries that are harder to see. This happens because our brains are suspended inside our skulls in “cerebral fluid,” and can therefore move inside our skulls. In a car accident when someone’s head moves rapidly back and forth, the brain often gets compressed against the one side of the interior of the skull. Then when the head rebounds or bounces back, the brain can get pressed against the opposite side of the skull. Doctors call this a “coup-contrecoup” injury. This compression of the brain can cause injuries like bleeding, lesions, hemorrhaging, or swelling. In severe cases, the swelling following a car accident may be severe that surgery is required. Doctors may actually open the skull to relieve pressure on a swelling brain.
Modern medicine is just beginning to understand the human brain. The symptoms of concussions or traumatic brain injuries following car accidents can vary widely. Common symptoms include persistent headaches, disorientation, vertigo, amnesia or difficulty remembering, anger, or even personality changes. In severe cases, some of these symptoms may be permanent. Even in less severe cases, the symptoms of a brain injury may not finish improving – in other words, the car accident victim may not reach what doctors call “maximum medical improvement” – for up to two years.
Broken Bones and Orthopedic Injuries in Car Accidents
With airbags and other modern safety measures, broken bones and orthopedic injuries are less common in car accidents than they used to be. Still, they happen.
Broken bones are normally caused by intrusion into the passenger compartment of the car. In severe cases, a car accident can crush a vehicle entirely. Those car accidents cause fatalities and become wrongful death cases. Where the car accident isn’t quite that severe, arms, legs, or ribs may be broken. Hand and wrist injuries are common because if a person is holding the steering wheel when the accident occurs (as most of us are) and if the forces of the car accident force the person’s body forward, the pressure on the person’s hands and wrists can cause fractures. In one car accident case we handled, our client’s thumb was forced backward so hard that doctors had to perform surgery in his forearm to relieve pressure on the ulnar nerve – a type of surgery normally reserved for carpal tunnel syndrome.
Some orthopedic surgeries following car accidents have to be performed on an emergency basis, meaning that doctors have to act fast to save the car accident victim from something worse. Emergency orthopedic surgeries often involve plates, screws, and other hardware. An emergency surgery after a car accident usually seeks to stabilize the broken bone or injured area – in other words, the goal is to make sure things don’t get worse. Usually, an emergency surgery like that isn’t the final step. Physical therapy usually follows. Months or years later, the car accident victim often needs a second surgery, either to remove the hardware from the first surgery (if the bone has healed and the hardware is causing pain) or to reconstruct the affected area in a way that will give the car accident victim more long-term mobility and comfort.