Addressing scientific limitations of common causation opinions in spinal and traumatic brain injury litigation

To critically examine ten commonly asserted defense medicolegal opinions encountered in crash-related spinal and traumatic brain injury litigation, evaluate their scientific validity against the peer-reviewed literature, and provide an evidence-based framework for countering unsubstantiated forensic opinions.

Narrative evidence-based review informed by systematic analysis of defense medical evaluation reports. The authors, two physiatrists with extensive clinical and forensic experience, reviewed more than 800 compulsory medical evaluations (CMEs) prepared by defense-retained physicians in spinal and brain injury litigation over three decades (1987-2025). The ten most clinically significant and frequently recurring defense opinions (five pertaining to spinal injury and five to traumatic brain injury) were selected for analysis. A comprehensive literature search was conducted to identify any literature supporting the defense opinions under review.

No peer-reviewed scientific literature was identified in support of any of the ten defense opinions examined. For spinal injuries, the reviewed literature refutes the assertions that low-velocity motor vehicle crashes (MVCs) cannot cause disc injury; that post-crash disc pathology is invariably pre-existing and degenerative; that spinal injury requires MRI confirmation; that radiculopathy requires visible nerve root compression; and that MVC-related spinal injuries uniformly resolve within 6-12 weeks. For traumatic brain injury (TBI), the literature refutes the assertions that TBI requires a direct blow to the head, loss of consciousness (LOC), or an abnormal Glasgow Coma Scale (GCS) score; that TBI must be diagnosed at the scene or in the emergency department; that TBI diagnosis requires hemorrhage or gross structural abnormality on conventional neuroimaging; that a normal focal neurological examination excludes TBI; and that TBI prognosis is uniformly favorable with no increased risk of dementia.

Ten forensic defense opinions commonly advanced in spinal and brain injury litigation are each contradicted by robust peer-reviewed evidence and lack any identifiable scientific foundation. These unsubstantiated maxims grounded in anecdotal clinical experience rather than the medical literature distort causation analysis and undermine legitimate injury claims. Accurate forensic evaluation of crash-related spinal and brain injuries requires integration of biological plausibility, individual vulnerability, clinical evolution, advanced neuroimaging, and long-term outcome data, consistent with current scientific and diagnostic standards.