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Case study 18 - lumbar spine L5/S1 disc protrusion and radiculopathy

Overview

An example of an Insurer correctly assessing Minor Injury.

Introduction

The Claimant was the driver of a vehicle which was hit from the right at approximately 45 km/s per hour. No immediate pain was reported by the claimant, who drove from the scene to a location and returned home approximately 4 hours later. Upon returning to their home, the claimant reported right lumbar discomfort. Over the coming day, pins and needles were reported to occur down the right leg.

The claimant attended hospital the night of the motor vehicle accident (MVA), where bilateral low back pain was reported, radiating to sharp pain down the leg. It was reported that the pain was worse when sitting down. A CT scan was completed the following day and no fracture was noted to be present, L4/5 had a small posterior disc bulge not compromising the central canal.

The Medical Assessment

There is a dispute as to whether the injury is a minor injury under scheduled 2 section 2(e) of the Act.

The claimant was assessed approximately 8 months post MVA. The claimant described significant pain in the back.

On Examination

Lumbar (Lumbosacral) spine

  • No obvious foot drop, can easily stand on his heels.
  • Slight hyper pronation of both hind feet
  • Lumbar flexion loss of 1/3 range of motion, pulling noted in the right buttock and upper posterior right thigh.
  • No muscle spasm, nor guarding.
  • 1/3 loss of lateral flexion, 2/3 loss of right lateral flexion.
  • Straight leg raise was 45° on the right, and 80° on the left in the lying position.

Wasting was noted on the right calf 2cm, and 1 cm at the thigh. On lower reflex examination, there was a slight but definite diminution of right ankle reflex.

No muscle weakness was noted, however 3 clinical signs of lumbar radiculopathy. It is noted these symptoms are consistent with a right S1 nerve root compression.

Diagnosis

L5/S1 central disc protrusion with right sciatica with right sided low back pain and right S1 radiculopathy.

L4/5 posterior disc bulge

Minor injury

Section 1.6(2) of the Motor Accidents Injuries Act 2017 (the Act)

A soft tissue injury is (subject to this section) an injury to tissue that connects, supports or surrounds, other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.

Schedule 1 [2] clause 4 of the Motor Accident Injuries Regulation 2017:

  1. An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.

The lumbar spine L5/S1 disc protrusion and radiculopathy is therefore not a minor injury.