Central neurological injury
Spinal cord injury after a motor accident
A spinal cord injury is a central nervous-system injury, not an ordinary back-pain diagnosis. It may affect motor power, sensation, gait, tone, breathing, bowel, bladder, sexual function and independence. The claim file should identify the neurological level and completeness of the injury, the associated spinal pathology and the separate treatment, care and permanent impairment questions.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
Fracture-dislocation, disc compression or severe flexion-extension can damage the cervical or thoracic cord.
Side-impact crash
Lateral trauma may produce fracture, canal compromise or cord contusion.
Motorcycle fall
Axial loading or direct back impact can cause burst fracture, cord contusion or compression.
Pedestrian impact
Direct collision and ground impact can combine vertebral, pelvic and neurological trauma.
Injuries and diagnoses that may follow
- complete or incomplete spinal cord injury
- cord contusion, compression or haemorrhage
- central cord or another spinal cord syndrome
- tetraplegia, paraplegia or incomplete motor/sensory deficit
- associated vertebral fracture, dislocation, disc prolapse or nerve-root injury
Symptoms that should be recorded accurately
- weakness or paralysis
- sensory loss or altered sensation below a level
- gait, balance, tone or reflex change
- bowel, bladder or sexual dysfunction
- pain, spasticity, autonomic or care needs
Urgent medical signs
New weakness, sensory loss, breathing difficulty, bladder or bowel change or worsening neurological signs after spinal trauma requires urgent emergency assessment.
Clinical evidence
What medical findings matter?
The evidence should record the neurological level, motor and sensory findings, completeness, sacral function and associated fracture or disc injury. A central cord lesion must be distinguished from cauda equina, nerve-root and peripheral nerve injury because the methods differ.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| Emergency neurological exam | Records motor level, sensory level, reflexes, tone, sacral findings, gait and bladder/bowel symptoms. | A general description of weakness does not establish lesion level or permanence. |
| MRI/CT | Shows cord signal, canal compression, disc, fracture or haematoma. | Imaging must be connected to the neurological examination and accident causation. |
| Rehabilitation assessment | Documents transfers, mobility, self-care, continence, equipment and assistance needs. | Support needs do not replace the medical impairment method. |
| Respiratory, urology and bowel records | Can provide objective evidence of associated respiratory or autonomic dysfunction. | Symptoms alone do not establish a separately assessable neurological function. |
Part 5 classification
Is this likely to be threshold or non-threshold?
An objectively established spinal cord injury is a central neurological injury and is not merely a soft tissue strain. It may therefore support non-threshold classification. Where the evidence shows only neck or back pain, imaging change without cord injury, or unverified neurological symptoms, the insurer may still classify the spinal condition as threshold.
Evidence that may support a threshold classification
- back or neck pain without objective central injury
- unverified limb symptoms
- imaging change without neurological correlation
Evidence that may support a non-threshold injury
- objectively established cord injury
- central motor or sensory deficit linked to the lesion
- fracture/dislocation with neurological injury
- verified nerve injury outside the soft tissue definition
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?
Clause 6.161 requires motor or sensory impairment from a central spinal cord lesion to be assessed under AMA4 section 4.3 and combined as applicable. The result is then combined with the associated spinal DRE assessment from Chapter 3.3 as modified by Part 6.
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.
- The neurological assessment identifies motor, sensory and other objectively affected spinal cord functions.
- Spinal cord motor and sensory impairment is not replaced by a DRE category; clause 6.161 requires the applicable nervous-system and associated spinal components to be combined.
- Respiratory, bladder, anorectal or sexual dysfunction requires objective evidence and the applicable AMA4 Chapter 4 station or body-system method.
- The assessor must avoid counting the same motor or functional loss twice.
- Care, equipment and rehabilitation evidence are important to treatment and benefits but do not generate a self-calculated WPI.
What does not establish the result by itself?
- back pain alone
- subjective weakness without neurological examination
- MRI compression without matching central deficit
- bowel/bladder complaint without objective evidence
- adding care hours as a WPI percentage
Accident-specific examples
Cervical fracture with incomplete cord injury
The assessor may combine nervous-system motor/sensory impairment under section 4.3 with the associated cervical DRE under clause 6.161.
Thoracic burst fracture with paraplegia
The fracture, central motor/sensory loss and associated thoracolumbar DRE are assessed under their applicable methods and combined without duplicating function.
Back pain with intermittent tingling but normal cord function
This does not establish spinal cord impairment. The claim may instead involve soft tissue, radiculopathy or peripheral nerve analysis.
Claim file preparation
Evidence checklist
Assessment source
Spinal cord injury impairment source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.156-6.163, especially 6.158 and 6.161; AMA4 Chapter 4 section 4.3 and the associated Chapter 3.3 DRE, as modified by Part 6.
Threshold injury: Objectively established spinal cord injury is not a soft tissue injury. Unverified neurological symptoms do not establish a central lesion.
What the assessor checks
- central motor/sensory impairment method
- associated DRE combination
- objective evidence for other cord functions
- no duplicate functional rating
What does not establish the result by itself
- pain alone
- scan alone
- subjective weakness
- care needs as a percentage
Official sources
Related NSW CTP guides
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Frequently asked questions
- How is spinal cord WPI assessed?
- Central motor or sensory impairment is assessed under AMA4 section 4.3 and combined with the associated spinal DRE under clause 6.161.
- Is spinal cord injury the same as radiculopathy?
- No. Spinal cord injury is a central lesion. Radiculopathy concerns dysfunction of a spinal nerve root and uses the specific two-sign rule.
- Can bowel or bladder symptoms be assessed?
- Potentially, but objective evidence of spinal cord, cauda equina or bilateral nerve-root dysfunction is required and the applicable body-system rules must be used.
- Do care and equipment needs affect WPI?
- They are important functional and statutory-benefit evidence, but they do not themselves set the WPI percentage.
- Does a spinal fracture automatically prove cord injury?
- No. Imaging must be correlated with the neurological examination. A fracture and a spinal cord injury are separately identified components.
- Is the DRE method still used?
- Yes, for the associated spinal impairment. Clause 6.161 combines that DRE component with the applicable central motor or sensory impairment.