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

2 How to win Neurosurgical Personal Injury CasesPresented 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!

6 Whiplash

7 Getting old is a Bitch!

8 Can you tell the difference?!

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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 conditionsDegenerative 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 discCan be painful

18 Conditions that are not easily attributable to trauma!

19 Spondylolisthesis

20 Spinal Stenosis

21 Degenerative Disc Disease

22 Traumatic Brain Injury

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24 Glasgow Coma Score Eye Verbal Motor Perfect Score 151 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 SyndromeHeadaches 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 ProtocolImaging 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