BACK CONDITION
1.PERSONAL DETAILS
NAME: Albert Smith
DATE OF BIRTH: 5 May 1951
EMPLOYER: Department of Files and Letters
DATE OF INJURY: 25 December 1988
2.INJURY
On 25 December 1988, Mr Smith was putting away a box of files when he sustained a back injury, described as a pain across the lumbar back, radiating along the posterior aspect of the left leg to the knee. Liability was found for aggravation of a pre-existing condition namely lumbo-sacral disc lesion.
He has had two previous compensable episodes of back strain:
20/05/1980:Acute back strain due to lifting a tin and books resulting in incapacity for 10 days.
18/02/1982:While getting into the car to go to work felt his back "go". Off work 18 February 1982 to 28 June 1982. Dr Sharp reported in May 1982 "has a history suggestive of lumbar disc protrusion but.....no localising neurological signs".
3.INCAPACITY
Mr Smith was incapacitated for work:
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26/12/1988 to 13/01/1989
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13/04/1989 to 17/04/1989; and
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continuing from 20/04/1989 to the present.
4.REHABILITATION
At the interview with Rehabilitation Services Pty Ltd on 10/01/1989, it was apparent that Mr Smith had become quite depressed and an early return to work was indicated.
A return to 3 hours work per day was agreed, on the understanding that he would be able to move around as his condition required.
This resumption of work lasted six weeks. On 12/04/1989, Mr Smith reported some pain and discomfort and has been absent since 20/04/1989.
5.MEDICAL EVIDENCE
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C.1Dr Robert Dempsey 15/10/89
SLR 90% both sides, not painful. Reflexes in legs normal. X-rays show narrowing of the lumbo-sacral disc. Cat scan normal.
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C.2Dr Robert Dempsey 11/12/89
SLR on right side produces left buttock pain, left side is painful at 45°, but no true sciatic pain. X-rays demonstrate traction spurs at L4/5 and L5/S1.
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C.3Fred Meadows 25/9/89
C.T. scan films 19/9/89 confirm degenerative changes of L5/S1 but no disc protrusions were seen at this level or at L4/5 and L3/4.
Mr Smith was able to squat fully and rise easily from full squat position.
Slight reduction of sensation in left S1 dermatome. No wasting, circumference of right thigh equal to left, right calf equal to left calf.
All movements of LS spine voluntarily restricted, accompanied by voluntary spasm.
Patient able to sit on couch with lower limbs extended and leaning slightly forward with his trunk. When spine SLR actively voluntarily restricted by generalised muscle spasm at 40° on the right and 20° on the left.
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C.4John Blackman 1/12/89
SLR on left limited to 30° with acute left sided sciatica. SLR right 50°. Maximal tenderness at L5/S1 level.
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C.5Robert Simpson 11/2/90
Extension markedly limited, associated with pain. Forward flexion markedly limited. SLR 60° right, 30° left. Left calf 2cm larger than right. Diminished sensory perception left leg in stocking distribution up to the knee. Reflexes normal in lower limbs.
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C.6Dr Robert Dempsey 25/1/90
Clinically the patient has a lumbar disc prolapse with nerve root compression.
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C.7Alex Brown 14/3/90
Evidence of disc degeneration at L4/5 and L5/S1 levels. Evidence of left postero lateral protrusion at L4/5 disc. Quite large posterior disc protrusion at L5/S1, larger in the midline and to right of midline.