Vertebral fracture assessment
Spinal fracture after a NSW motor accident
Spinal fracture assessment is not a single surgery-based percentage. Part 6 distinguishes vertebral body compression, posterior-element fractures, transverse or spinous process fractures, end-plate fractures and multiple qualifying vertebral fractures, then asks whether radiculopathy is present.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
High-force deceleration or seat loading can produce compression or flexion-distraction injury.
Side-impact crash
Lateral compression and rotation can cause vertebral body or posterior-element injury.
Motorcycle fall
Landing on the head, back, pelvis or feet can transmit axial load and cause fracture at one or more levels.
Pedestrian impact
Direct impact and ground contact can cause spinal and pelvic fractures with possible neurological injury.
Injuries and diagnoses that may follow
- vertebral body compression fracture
- posterior-element fracture involving pedicle or lamina
- transverse or spinous process fracture
- end-plate fracture
- fracture-dislocation or multiple vertebral fractures
Symptoms that should be recorded accurately
- focal spinal pain and tenderness
- movement and load intolerance
- rib or chest symptoms with thoracic fractures
- arm or leg neurological symptoms
- gait or bowel/bladder change where cord or cauda equina involvement exists
Urgent medical signs
Suspected acute spinal trauma, fracture or worsening neurological signs requires urgent medical assessment.
Clinical evidence
What medical findings matter?
The fracture must be identified by level and structure. Compression measurement, stability, canal deformity, number of qualifying vertebrae and radiculopathy all matter.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| Lateral X-ray | Preferred by clause 6.148 for vertebral compression measurement when the beam is parallel to disc spaces. | A small image or unverified radiology estimate may be inaccurate. |
| CT | Defines fracture anatomy, posterior elements, canal deformity and compression when suitable X-ray is unavailable. | CT still requires clinical and neurological correlation. |
| MRI | Can show marrow oedema, ligament, disc, cord and nerve-root involvement. | It does not replace the fracture-specific DRE rules. |
| Neurological exam | Determines whether radiculopathy, cord or cauda equina injury accompanies the fracture. | Pain-limited weakness is not verified root dysfunction. |
Part 5 classification
Is this likely to be threshold or non-threshold?
An accident-related bone fracture is not merely a soft tissue injury and generally supports a non-threshold classification. The insurer may still dispute causation, whether the fracture is acute, or whether a claimed neurological injury is established.
Evidence that may support a threshold classification
- soft tissue pain without a verified fracture
- old or incidental fracture not caused or aggravated by the accident
- neurological complaints that do not meet radiculopathy or central-injury criteria
Evidence that may support a non-threshold injury
- verified acute accident-related vertebral fracture
- fracture-dislocation
- posterior-element fracture forming part of the spinal canal ring
- associated radiculopathy, cord or cauda equina injury
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?
Table 6.7 and clauses 6.143-6.151 provide fracture-specific DRE rules. The assessor must classify the actual pattern and document compression calculations rather than infer WPI from treatment intensity.
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.
- Table 6.7 places vertebral body compression under 25% in DRE II and 25-50% in DRE III; compression over 50% falls in the higher IV/V structural columns according to the applicable descriptor and radiculopathy.
- Clause 6.149 places one or more displaced transverse or spinous process fractures in one region in DRE II.
- Clause 6.150 places one or more end-plate fractures in one region without measurable body compression in DRE II.
- Multiple qualifying vertebral fractures are DRE IV without radiculopathy and DRE V with radiculopathy under clause 6.151.
What does not establish the result by itself?
- pain without verified fracture
- radiology percentage copied without assessor measurement
- multiple transverse/spinous process fractures treated as multilevel structural compromise
- predicted future degeneration
- surgery alone
Accident-specific examples
Single end-plate fracture without measurable compression
Clause 6.150 specifies DRE II within that spinal region.
Two vertebral body fractures without radiculopathy
If they meet the clause 6.144 definition, clause 6.151(a) places multilevel structural compromise in DRE IV.
Multiple qualifying fractures with radiculopathy
Clause 6.151(b) places the pattern in DRE V, with radiculopathy independently verified under the two-sign rule.
Claim file preparation
Evidence checklist
Assessment source
Spinal fracture DRE source
Assessment source: Motor Accident Guidelines v10.1 Table 6.7 and clauses 6.111-6.133, 6.143-6.151; Table 6.8 for neurological findings; AMA4 DRE descriptors as modified.
Threshold injury: A verified accident-related vertebral fracture is not a soft tissue injury. Neurological consequences still require their own clinical proof.
What the assessor checks
- compression measurement method
- specific DRE II fracture rules
- multilevel fracture IV/V rule
- radiculopathy must be independently verified
What does not establish the result by itself
- pain alone
- estimated compression alone
- fracture count without the clause 6.144 definition
- operation alone
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is every spinal fracture DRE III?
- No. Part 6 has specific rules ranging across categories depending on fracture type, compression, structural pattern and radiculopathy.
- How is compression measured?
- Clause 6.148 compares the compressed vertebra with adjacent normal vertebrae using suitable lateral X-ray or CT and requires the calculation to be documented.
- Do multiple spinous-process fractures create DRE IV?
- No. Clause 6.144 excludes transverse and spinous process fractures from multilevel structural compromise, and clause 6.149 places displaced examples in DRE II.
- Does vertebroplasty set the WPI?
- No. Clause 6.147 says vertebroplasty is assessed on the basis of the fracture for which it was performed.
- Can a healed fracture still have WPI?
- Potentially. DRE assessment considers the verified structural pattern, clinical findings and applicable descriptors, not simply whether the fracture has united.