Abstract
A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.
Highlights
Neck pain (NP) is a significant health problem globally, ranking fourth in terms of years lived with disability [1]
It concluded that a physical examination of the cervical spine for the purpose of diagnosing of cervical facet pain lacked validity [27]
I accept that the diagnostic study conducted by Dr Shapero in December 2001 provides objective evidence confirming the injury to Mr McDonald’s cervical facet joints and that they were a source of his chronic pain [61]
Summary
Neck pain (NP) is a significant health problem globally, ranking fourth in terms of years lived with disability [1]. The cervical facet joints ( known as joints) are a common source of pain in the post-MVC [8]. Medial branch zygapophysial joints) anatomical are a common anatomical source of pain in NP the population post-MVC NP [8]. Blocks (MBBs) the (MBBs) best diagnostic test diagnostic for identifying cervical facet etiological pain. Medial branch are blocks are the best test for identifying cervical facet etiological facet joints located between each cervical vertebra of the C2-7 levelsofofthe theC2-7 spine, eachofwith.
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