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Appendix B: Bruce’s Case

Bruce’s case is even more dramatic than Gina’s in objectively proving accelerated degeneration secondary to ligamentous injury.
Bruce was injured in a car accident when he was 45 years old. His MRI showed some generalized degeneration, mostly mild
desiccation and some facet arthrosis which would be typical and expected for a 45-year-old with a history of doing physical labor
while working as a carpenter/fix-it-man, but nothing significant.

Four years later, a DMX showed major ligamentous laxity-much more than would occur naturally, especially when considering that he
totally stopped doing any significant physical work after his accident.

IMPRESSION for patient BRUCE:
• Damage to the posterior longitudinal ligament is indicated by an anterolisthesis at C3 on C4.
• Damage to the capsular ligament is indicated by intervertebral foraminal encroachment of the facet joint at C3-
C4 bilaterally.
• Damage to the alar and accessory ligaments is indicated by an overhang of the lateral mass of C1 to the left.

Again, repeat MRIs showed dramatic accelerated degeneration with 3 large herniations and impingement on the nerve roots at all 3
levels:

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