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Case study 44 - minor injury

Overview

This case examines whether injuries to the cervical spine and lumbar spine meet the definition of a minor injury in accordance with the Motor Accident Injuries Act 2017 (the Act).

Introduction

The claimant was the driver of a stationary vehicle at traffic lights. The claimant’s vehicle was hit from behind by another car. The claimant drove home after the accident. The claimant’s vehicle sustained no damage.

Two days after the accident, the claimant began to develop pain in the neck and back. The claimant subsequently attended a general practitioner (GP) and was referred for x-rays and physiotherapy. The claimant was also reviewed by a neurosurgeon who wanted to operate. The claimant received a CT guided injection into the spine which only provided a brief amount of relief.

At the time of examination, the claimant complained of a stiff neck. The claimant noted that the pain is worse in the back and that pain ‘comes and goes’ down the left leg.

Current treatment consists of physiotherapy and analgesic medication.

The Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Act.

Clinical Examination

Cervical Spine

  • There was diffuse tenderness to palpation
  • No muscle spasm and no alteration of spinal contour
  • Full range of flexion, extension and rotation

Thoracic Spine

  • There was no diffuse tenderness to palpation
  • No muscle guarding or spasm
  • No evidence of dysmetria

Lumbar Spine

  • Demonstrated three quarters of the normal range of flexion
  • Half the normal range of extension and half the normal range of rotation
  • Flattening of the lumbar lordosis, but no paraspinal muscle spasm
  • No other abnormality was detected in the lumbar spine

Upper Extremity

  • Normal abduction and flexion in both arms
  • Reflexes, sensation and power intact
  • No unilateral muscle wasting
  • No sensory disturbance

Lower Extremity

  • Right lower extremity was normal in all respects with a normal range of movement at the hip, knee and ankle
  • Left lower extremity exhibited discomfort on full flexion of the hip. Normal knee and ankle movement

Review of Documentation

GP clinical notes confirm the presence of back pain with pain down the left leg.

Specialist report states findings of pain radiating down the left leg to the knee. Decreased sensation to light touch to the lateral border of the left foot. Normal and symmetrical reflexes. Power is normal and no nerve root tension sign.  Fibrous tissue rupture of the annulus of the L5/S1 disc and radicular symptoms and objective signs of radiculopathy.

X-ray cervical spine reported a loss of cervical lordosis with multilevel narrowing of the disc spaces.

X-ray lumbar spine reported anterolisthesis of L4/5 Grade 1 and again multilevel degenerative changes. There is also noted to be anatomical wedging of L1.

MRI of the lumbar spine reports a disc bulge at L2/3. At L5/S1 there is a bilateral degenerative facetal arthropathy with a posterior bulge and annular fissure of the disc. At S1/S2 there is noted to be a left posterocentral disc protrusion.

Diagnosis

The claimant’s clinical history is consistent with a soft tissue injury of the cervical spine. There is also a soft tissue injury to the lumbar spine aggravating pre-existing degenerative changes.

The claimant does not qualify for disc injury with radiculopathy.

The following injuries WERE caused by the motor accident:

  • Cervical Spine – soft tissue injury
  • Lumbar Spine – soft tissue injury

Minor Injury

Section 1.6(2) of 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 following injury is a minor injury:

  • Neck
  • Back