Lumbar spine claim
Back and lumbar spine injury after a motor accident
Low-back claims range from muscle strain and facet pain to disc prolapse, radiculopathy, fracture and cauda equina injury. The legal result does not follow from the word sciatica or the size of a disc bulge. It follows from the accident history, repeated examination and the Part 5 and Part 6 criteria.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
Seat loading and torso movement can strain lumbar tissue or aggravate a disc, particularly where rotation or bracing occurs.
Side-impact crash
Lateral bending and pelvic movement can load lumbar discs, facets and sacroiliac structures asymmetrically.
Motorcycle fall
Landing on the hip, buttock or feet can transmit compression and rotation through the lumbar spine.
Pedestrian impact
Direct impact and a secondary fall can cause disc injury, vertebral fracture or pelvic injury.
Injuries and diagnoses that may follow
- lumbar muscle or ligament strain
- facet joint injury
- disc bulge, protrusion or extrusion
- lumbar radiculopathy
- vertebral fracture, stenosis aggravation or cauda equina injury
Symptoms that should be recorded accurately
- local low-back pain
- buttock or leg pain
- numbness or tingling in a dermatomal pattern
- focal weakness or foot drop
- reduced sitting, lifting, bending, walking or driving tolerance
Urgent medical signs
Acute bladder or bowel loss, saddle sensory change, bilateral weakness or rapidly progressive foot drop requires urgent medical assessment.
Clinical evidence
What medical findings matter?
Lumbar examination should distinguish local back pain, referred pain, non-verifiable radicular complaints and objective lumbosacral nerve-root dysfunction.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| Straight-leg raise | A positive test reproduces thigh or leg pain in the appropriate dermatomal distribution; the angle and side should be recorded. | Back pain or hamstring tightness on SLR is not a positive nerve-root tension sign. |
| Reflex, power and sensation | Maps neurological findings to L4, L5 or S1 and checks repeatability. | Global leg weakness from pain inhibition is not root weakness. |
| Lumbar MRI | Shows disc, foraminal, canal or fracture pathology that may explain the clinical pattern. | Clause 6.121 warns that bulges and herniations are common without symptoms. |
| CT or X-ray | Can define fracture, compression, alignment or bony pathology. | A radiology estimate of compression should not replace the assessor measurement required by clause 6.148. |
Part 5 classification
Is this likely to be threshold or non-threshold?
Lumbar strain and back pain without an excluded injury may be threshold. Leg pain described as sciatica may still be threshold if it does not meet the two-sign radiculopathy criteria. Fracture, cauda equina injury or verified radiculopathy may support non-threshold classification.
Evidence that may support a threshold classification
- lumbar sprain or strain
- back or buttock pain without nerve dysfunction
- leg pain or tingling without two objective signs
- disc bulge without clinical correlation
Evidence that may support a non-threshold injury
- two or more lumbosacral radiculopathy signs
- vertebral fracture caused by the accident
- cauda equina or spinal cord pathology
- verified nerve injury or excluded rupture
Radiculopathy means two or more clinical signs, not pain alone
Clauses 5.7-5.9 and 6.138-6.142 require dysfunction of a spinal nerve root with two or more of the following signs found on examination:
- 1.loss or asymmetry of reflexes
- 2.positive sciatic nerve-root tension signs
- 3.muscle atrophy or decreased limb circumference
- 4.muscle weakness anatomically localised to the appropriate spinal nerve-root distribution
- 5.reproducible sensory loss anatomically localised to the appropriate spinal nerve-root distribution
Pain, burning or tingling that follows a nerve-root pattern but lacks objective neurological findings is a non-verifiable radicular complaint under Table 6.8. If the neck or spine symptoms do not meet the radiculopathy criteria, clause 5.9 says the injury is assessed as threshold.
Part 6 permanent impairment
How is WPI assessed for this injury?
Lumbar WPI uses the lumbosacral DRE descriptors in AMA4 pages 102-103 as modified by Part 6. Symmetric restriction is not dysmetria, and multiple impairments in the lumbar region are not added; the highest category is chosen.
CTP spine method: clause 6.111 requires the DRE method. The spinal ROM model and AMA4 Table 75 are not used, and clause 6.123 says loss of motion segment integrity is not applied.
| Category | Human-language guide to the verified CTP rule |
|---|---|
| DRE I | Symptoms are present, but the medical assessor finds no objective clinical findings that place the injury in a higher category. This is the rule stated in clause 6.129. |
| DRE II | The assessor finds qualifying clinical findings, such as guarding, reproducible non-uniform motion or non-verifiable radicular complaints, or a specified stable fracture pattern, but not verified radiculopathy or a higher structural inclusion. |
| DRE III | This category includes verified radiculopathy and specified fracture or dislocation patterns identified in Table 6.7. Radiating pain without the required neurological signs is not enough. |
| DRE IV | This is a higher structural category. One verified example is multiple qualifying vertebral fractures without radiculopathy under clause 6.151(a). Fusion and disc replacement are treated as multilevel structural compromise under clause 6.145, but surgery does not by itself supply a fixed percentage. |
| DRE V | This is the higher structural category where the applicable descriptor includes radiculopathy. Clause 6.151(b), for example, places multiple qualifying vertebral fractures with radiculopathy in category V. |
A DRE category is not a percentage to calculate from symptoms. The assessor must use the region-specific AMA4 descriptors on pages 102-107 as modified by clauses 6.125-6.132 and explain the tables or figures used, as required by clause 6.122.
- DRE II requires clinical findings observed by the medical assessor under the modified descriptors.
- Radiculopathy is a DRE III differentiator when the two-sign rule is satisfied.
- Separate spinal regions can be combined, but multiple findings within one region cannot be added.
- Imaging must be concordant and the report must explain the calculation and sources used.
What does not establish the result by itself?
- low-back pain alone
- a chart note saying sciatica without signs
- back pain during SLR
- MRI disc degeneration alone
- symmetric movement loss
Accident-specific examples
Rear-end crash with back pain but no leg findings
This may be a threshold soft tissue injury. For WPI, the assessor decides between DRE I and a higher category based on objective findings, not pain duration.
Lumbar prolapse with SLR leg pain and reproducible sensory loss
These may constitute two qualifying signs if they follow the same root distribution and are accident-related.
Pedestrian impact with compression fracture
The fracture is structurally distinct from a lumbar strain. Compression should be measured under clause 6.148 and classified under Table 6.7.
Claim file preparation
Evidence checklist
Assessment source
Lumbar spine threshold and WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 5.7-5.9, 6.111-6.153, Tables 6.7 and 6.8; AMA4 lumbosacral DRE descriptors as modified by clauses 6.125-6.132.
Threshold injury: Lumbar pain or sciatica-like symptoms may remain threshold unless the evidence establishes qualifying radiculopathy or another excluded injury.
What the assessor checks
- SLR definition in Table 6.8
- DRE-only assessment
- imaging correlation rule
- highest category within one region
What does not establish the result by itself
- back pain
- back pain on SLR
- disc bulge alone
- sciatica label alone
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is sciatica the same as radiculopathy?
- Not necessarily. Sciatica may describe pain. CTP radiculopathy requires two or more specified clinical signs.
- Is a positive SLR enough?
- One sign alone is not enough for the Part 5 radiculopathy test, and the test must reproduce leg pain in an appropriate dermatomal distribution.
- Does an MRI extrusion make the injury non-threshold?
- Not automatically. The imaging must fit the history and clinical findings, and the diagnosed injury must fall outside the statutory soft tissue definition.
- How is lumbar WPI assessed?
- By the modified DRE method, not spinal ROM. The assessor applies Table 6.7, Table 6.8 and the modified AMA4 lumbosacral descriptors.
- Can pre-existing degeneration be deducted?
- Only through a reasoned causation and pre-existing impairment analysis. Degeneration on imaging is not automatically a deduction.