Academy of Chiropractic’s Doctors PI Program
Lawyers & Medical Narrative #62
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“Documenting Age Dating Herniations”
A very special thanks to Dr. Richard Laviano for helping formulate this discussion.
When age dating herniations, one of the 3 accepted arguments is the piezoelectric effect that is the foundation for Wolff’s Law. Suggested language for a narrative is:
The herniated disc at C4-C5 affects the C5 nerve and innervates the deltoid and biceps muscles which clinically correlates to the patient’s initial presentation of decreased motor strength in these areas. When looking at the images there is no infiltration of calcium at the area of the protrusion of C4-C5 disc. Wolfe law states that a bone will adapt to the loads upon which it is placed. When there is a herniation of an intervertebral disc, there is abnormal mechanical shearing thus creating an increase in negative charge within the joint capsule as compared to the osseous structures above and below. As a result, the trabecular bone will give a positive charge by means of calcium (Ca+) that infiltrates into the injured joint. This is called the piezoelectric effect. This can be usually visualized beginning at a minimum of 6 months’ post trauma. The osteophytic changes noted in other parts of the cervical spine as well as other aspects of the C4-C5 joint itself indicate previous injury. However, the lack of calcium infiltration and osteophytic changes around the protrusion type herniation at C4-C5 indicates that this herniation is acute in nature, causally related to the accident and clinically correlates with the patient’s condition. A clear contrast of this can be seen in the C3-C4 old herniation type protrusion above.
This should not be used in an E&M report.