Permanency Statement for Cervical and Lumbar Disc Herniations with Radiculopathy Following Motor Vehicle Crash
The patient has sustained permanent injuries to the cervical and lumbar spine with ongoing radiculopathy that will require lifelong management and accommodations, with significant impact on quality of life and functional capacity.
Diagnostic Findings to Document
- MRI confirmation of cervical and lumbar disc herniations with evidence of nerve root impingement 1
- Electromyography (EMG) and nerve conduction studies confirming radiculopathy
- Documentation of neurological deficits including:
- Sensory deficits in affected dermatomes
- Motor weakness in corresponding myotomes
- Reflex changes (hyporeflexia or areflexia)
- Positive tension signs (e.g., straight leg raise for lumbar, Spurling's test for cervical)
Permanent Functional Limitations
Physical Capacity
- Lifting restrictions: No lifting over [specific weight] pounds
- Limited ability to perform repetitive neck movements
- Limited ability to perform repetitive bending, twisting of lumbar spine
- Restricted duration for sitting, standing, and walking activities
- Limitations in overhead work activities
- Limitations in activities requiring sustained neck positions
Work Capacity
- Reduced work capacity compared to pre-injury status 2
- Inability to return to physically demanding occupations requiring repetitive lifting, bending, or twisting
- Need for ergonomic workstation modifications
- Requirement for position changes every [specific time interval]
- Limitations on driving duration due to neck pain and radiculopathy
Long-Term Prognosis
- Patient has reached Maximum Medical Improvement (MMI) after [duration] of treatment
- Permanent neurological deficits are present and unlikely to fully resolve
- High likelihood of progression to adjacent segment degeneration over time 1
- Risk of recurrent episodes of increased pain and radiculopathy with certain activities
- Ongoing need for pain management and functional maintenance care
Treatment Requirements
Ongoing Medical Management
- Regular follow-up evaluations every [specific interval]
- Periodic imaging to monitor progression of disc pathology
- Medication management for neuropathic pain
- Possible need for epidural steroid injections for symptom flares 1
- Potential need for surgical intervention if neurological status deteriorates 1
Rehabilitation Needs
- Maintenance physical therapy program
- Home exercise program for spine stabilization
- Periodic reassessment of functional capacity
Impairment Rating
Permanent impairment rating of [X%] for the cervical spine based on:
- Documented radiculopathy
- Range of motion deficits
- Neurological deficits
- Imaging confirmation of structural pathology
Permanent impairment rating of [Y%] for the lumbar spine based on:
- Documented radiculopathy
- Range of motion deficits
- Neurological deficits
- Imaging confirmation of structural pathology
Causation Statement
The patient's cervical and lumbar disc herniations with radiculopathy are directly attributable to the motor vehicle collision for the following reasons:
- No pre-existing spine pathology documented prior to the accident
- Temporal relationship between onset of symptoms and the collision
- Mechanism of injury consistent with acceleration-deceleration forces typical in motor vehicle accidents 3
- Pattern of disc herniations consistent with traumatic etiology rather than degenerative changes
- Medical literature supports increased frequency of cervical radiculopathy following motor vehicle accidents 3
Future Medical Needs and Costs
- Ongoing medication costs for pain management and neuropathic pain
- Periodic imaging studies (MRI every [specific interval])
- Interventional procedures as needed for symptom management
- Possible surgical intervention if condition deteriorates
- Durable medical equipment needs
- Home modifications if mobility significantly impaired
- Assistive devices as needed
Impact on Activities of Daily Living
- Permanent limitations in recreational activities
- Difficulty with household chores requiring bending, lifting, or overhead reaching
- Sleep disturbances due to pain and radiculopathy
- Driving limitations due to neck pain and reduced cervical range of motion
- Need for assistance with certain activities requiring sustained postures or heavy lifting
This permanency statement reflects the patient's current condition, which represents a significant and permanent change from their pre-injury status, with ongoing implications for quality of life, functional capacity, and future medical needs.