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Introduction Andrew Rayner is a 60-year-old left-handed boiler maker that has not worked since June 2020 by way of a road traffic accident injury. History represented complaint Andrew Rayner was on a motorbike on 12th June, 2020 with his wife on a separate motorcycle beside him. They were enjoying a joyful ride when unfortunately, a vehicle turned in front of Andrew, and he t-boned it, going over the vehicle onto the bonnet and ultimately landing onto the road. He suffered predominantly a right knee injury and right lower back injury. He went on to have treatment at the local emergency department that same day, and went on to see an orthopedic surgeon for his knee. He was sent for conservative treatment and exercises, and as things did not improve, he ultimately ended up having his knee done privately in June 2021. This was subsequently accepted as a road traffic incident by the TAC, and he has been compensated for this from a treatment point of view. Unfortunately, he also had pain and numbness running down his right leg at the same time, and an MRI scan proved this to be arising from his back, He was then sent on to see Dr Girish Nair, a neurosurgeon, who ultimately tried conservative treatment first and then went on to perform nerve conduction studies. This showed a moderate to severe right L5 radiculopathy, and he underwent an L4/5 decompression in December 2022. Unfortunately, he persists with some intermittent pain and significant numbness down his right leg and went on to physiotherapy thereafter, which has since ceased. Current symptoms His current symptoms were as follows; 1. Constant numbness in his right leg. He describes this as walking on marbles and so has altered the way he walks. 2. Some ongoing intermittent pain in his right leg. Current treatment

His current treatment regime is as follows; 1. Home exercises on a regular basis. 2. Walking 5 km a day. Past medical history His past medical history is only significant for minor back discomfort requiring physiotherapy, but this did not mandate any specific treatment, nor time off work, nor did he have any symptoms of previous sciatica. Education, occupation and social history Andrew Rayner was born in Victoria and finished high school early at the age of 16 or 17. He went on to the working industry and did night school as a boiler maker, going on to do an apprenticeship thereafter. He currently lives with his wife and has a daughter who lives out of home. He is a non-smoker and drinks one to two beers per day. Effects on lifestyle He describes the injuries as having significant impact on his lifestyle. He is no longer able to work by way of his symptoms and mobility. He is also unable to ride a pushbike, nor is he able to ride his motorbikes, for which he has a significant passion for. He would normally ride his bike four to five times per week, and since the accident, he has ridden it approximately four times in the last year or so. He is also unable to sit down for long distances and unable to ride in a car for long distances. He also owns his own motorhome, which they cannot use by way of injury and symptoms. He lives in a two-story home, and although he is able to do the stairs, he does struggle with them. He also describes his intimate relationship with his wife as non-existent now.

Investigations He has old reports from 2nd July, 2014. This is a CT scan of his lumbar spine for lower back pain and numbness on right anterior thigh. This shows some degenerative changes with no nerve impingement. And there is another CT scan from 2014 demonstrating annular tear at L4/5 and L5/S1 with a mild degree of posterior central disc bulge at these levels with no significant narrowing of the exit neural foramen. He has an MRI scan of his lumbosacral spine from 2022 done at Radius Imaging showing an L5/S1 small disc bulge with contact on the right L5 nerve root. He also has EMG studies from 12th August, 2022, showing moderate to severe right to L5 radiculopathy. The MRI scan from Radius Imaging is actually from 15th July 2022. This shows a disc degeneration L4/5 with a small right paracentral disc extrusion impinging on the budding right L5 nerve root. Examination on examination today, he clearly walks with antalgic gait and can only sit with his right leg extended. When he walks, he also does not flex his knee as he should and walks with a slightly circumflex gait as well. He otherwise has reasonable flexion to 80 or 90° and extension to 30° or so. He has stiffness at the extremes, but no significant pain. He has 3/5 EHL weakness on the right and 4/5 dorsiflexion weakness on the right. The rest of his examination was relatively normal with reflexes present. He does have a discrepancy in calf muscle circumferential diameter, with the right calf being approximately two centimeters smaller than the left. Diagnosis In my opinion, Andrew Rayner presents with the following; 1. Aggravation of L4/5 disc prolapse causing right leg sciatica. 2. Ongoing right L5 radicular symptoms. Causation

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In my opinion, the road traffic incident in June 2020 is likely causative of his L4/5 disc prolapse in the subsequent requirement for surgery. In my opinion, that incident remains the dominant contributing factor to his ongoing pain, disability and requirement for ongoing treatment. Work capacity In his current state, he does not have the capacity for his pre-injury employment. I do not think he has much in terms of realistic capacity when taking into account his age, education, training, skills, work, experience, as well as the nature and severity of his spinal condition for any alternative employment. In my opinion, this is long-term now. Treatment recommendations and prognosis I would recommend ongoing conservative management at this point. I do not believe that any further surgery is going to offer him any significant help. He should, however, in my opinion, have an up-to-date postoperative MRI to make sure that there is no evidence of any ongoing compression and an opinion from a treating spinal surgeon thereafter. Prognosis In my opinion, is such that he is likely to suffer the ongoing consequences of this injury now in the form of some degree of ongoing pain and disability into the foreseeable future. Answers to your specific questions as per your letter of instruction dated 27th November, 2023; A. Diagnosis is that of L4/5 disc prolapse and L5 radiculopathy. B. I do believe the transport accident to be causative of his right to L5 radiculopathy.

C. I do believe he has received appropriate treatment but would benefit from an up-to-date MRI scan due to his ongoing symptoms. D. He does require ongoing treatment in the form of Allied health treatment and may even require further surgery if the MRI scan shows ongoing compression. E. I do believe his condition is substantially stabilised with no improvement expected. F. I do not believe he has any realistic capacity for future work given his age, education, training, skills and work experience, as well as the nature and severity of his ongoing condition. G. Please see the section marked effects on lifestyle. H. He is likely to suffer further accelerated degenerative changes by way of this injury. This may affect his future social, domestic, recreational, and working life. I. There are consequential illnesses that may develop as a result of this, including obesity, diabetes, DVDs, et cetera, by way of limited mobility. A. I do believe that he qualifies for an AMA Guide rating by way of his radiculopathy. According to the SIGMD table, given he is required a single-level laminectomy, this qualifies him for a DRE category 2, but with clear signs of radiculopathy. As defined for table A, this now qualifies him for a DRE category 3, giving him a 10% lumbosacral whole-body impairment. B. He would benefit from an assessment to see whether or not he requires formal personal domestic assistance, but clearly is troubled by his back pain and radicular leg pain. C. As a consequence of his physical injury and impairment of his spine, he IS likely now to be precluded and restricted in relation to any activities involving any pushing, pulling, bending,

twisting, lifting, repetitive lumbar spine movements, or any prolonged sitting or standing. These are likely to continue into the foreseeable future. D. As a consequence of his physical injury and impairment to his spine, he is likely now to be precluded from performing his pre-injury duties for into the foreseeable future. E. I do not think he has the capacity for suitable employment. With regards to all the further material stating that the TAC would not claim responsibility of his L5 of the radiculopathy. I am of the clear opinion that his L5 radiculopathy is as a cause of his road traffic accident and the subsequent impingement on his L5 nerve route as a result of the significant trauma sustained in this injury. There is no doubt that the L5 radiculopathy is as a result of this injury causing an L4/5 change in the anatomy, which is subsequently causes pressure on his L5 nerve root, giving him the radiculopathy. He still has signs and symptoms of this currently. The conclusions drawn to the TAC regarding no link between the transport accident and the L5 by Mr Nair does not mean that the L5 radiculopathy did not come at the time of the accident because it clearly seems to be linked from the history and the radiological findings. I hope this clarifies my situation in the matter.

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