A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma.

Clinical determinations of causation in cases of intervertebral disk (IVD) injury after a motor vehicle crash (MVC) are often disputed in medicolegal settings. No published systematic guidelines exist for making such determinations, which has resulted in infringement by nonclinical personnel into injury causation evaluations, a traditionally clinical activity. The result is causal determinations that are potentially disconnected from clinical observations of injury. The purpose of this review was to evaluate the current literature on causation, causal determinations after trauma and IVD injury after MVC, and to develop a practicable, logical, and literature-based approach to causation determinations of symptomatic IVD injury after MVC. The results of the review indicate IVD injury can result from any MVC regardless of magnitude, thus meeting the first criteria of causation, biologic plausibility. Individual determinations of causation depend entirely on the temporal association between the collision and the symptom onset (the second criterion) and a lack of a more probable explanation for the symptoms (the third). When these causal elements are met, clinicians can assert causation on a "more probable than not" or "reasonable probability" basis. Because of a lack of an established or reliable relationship between collision force and the probability of IVD injury the investigation of collision parameters is not a useful adjunct to causal determinations.