(a) any medical or related treatment (other than domestic assistance) be given, or

(b) any hospital treatment be given, or

(c) any ambulance service be provided, or

(d) any workplace rehabilitation service be provided,

the worker's employer is liable to pay, in addition to any other compensation under this Act, the cost of that treatment or service and the related travel expenses specified in subsection (2).

Compensation for domestic assistance is provided for by section 60AA."

1. For the respondent to be liable for the claimed treatment s 60(1) of the 1987 Act requires that the treatment is reasonably necessary "as a result of an injury".
2. There is no dispute that the applicant sustained injury to her lumbar and cervical spine as a result of the motor vehicle accident in the course of her employment with the respondent on 27 July 2023.
3. Applying the commonsense test of causation the applicant bears the onus of establishing that the injury materially contributes to the need for the surgery.[1] The fact that pre-existing conditions may be factors in the need for treatment does not mean that the proposed treatment is not a result of the injury as Roche DP observed in Murphy:

"[57] ...a condition can have multiple causes (Migge v Wormald Bros Industries Ltd (1973) 47 ALJR 236; Pyrmont Publishing Co Pty Ltd v Peters (1972) 46 WCR 27; Cluff v Dorahy Bros (Wholesale) Pty Ltd (1979) 53 WCR 167; ACQ Pty Ltd v Cook [2009] HCA 28 at [25] and [27]; [2009] HCA 28; 237 CLR 656). The work injury does not have to be the only, or even a substantial, cause of the need for the relevant treatment before the cost of that treatment is recoverable under s 60 of the 1987 Act.

[58] Ms Murphy only has to establish, applying the commonsense test of causation (Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; 10 NSWCCR 796), that the treatment is reasonably necessary 'as a result of' the injury (see Taxis Combined Services (Victoria) Pty Ltd v Schokman [2014] NSWWCCPD 18 at [40]-[55]). That is, she has to establish that the injury materially contributed to the need for the surgery (see the discussion on the test of causation in Sutherland Shire Council v Baltica General Insurance Co Ltd (1996) 12 NSWCCR 716)."

1. There is no dispute that the applicant had suffered previous injuries to her neck and back.
2. It is the applicant's evidence that she suffered injury to her lower back and neck in or about 2017 when her vehicle was struck from behind by a truck and that in 2021, she suffered a fall injuring her neck in the course of her employment with a previous employer.
3. It is the applicant's evidence that by the time of the subject accident on 27 July 2023 she had recovered from her previous injuries and was working without restrictions.
4. Ms Compton submitted on behalf of the respondent that there is a lacuna in the evidence in that there are in evidence virtually no clinical records from prior to the accident on

27 July 2023. This lacuna in Ms Compton's submission raises an issue as to the applicant's condition prior to the injury on 27 July 2023. 5. It is a fact that there are virtually no clinical records prior to the accident on 27 July 2023 in evidence. There is however no indication that the applicant has attempted to hide the fact that she had suffered prior injuries to her lumbar and cervical spine. 6. The respondent has served as part of its evidence a statement of the applicant dated

30 August 2023.[2] In that statement which was made approximately one month after the accident the applicant describes how she had sustained injury to her neck in 2021 and her back in 2017 and how she had recovered from those injuries. The applicant further discussed her prior injuries in her subsequent statements of 28 July 2025 and 29 July 2025. 7. Whilst the available records prior to 27 July 2023 are limited, there is in evidence the reports relating to MRI scans performed of the lumbar spine on 19 September 2019 and cervical spine on 1 October 2021 which will be discussed further below. Also in evidence is a referral from Hassall Grove Medical Centre to the neurosurgeon and spine surgeon, A/Prof Ali Ghahreman, dated 18 October 2021 as well as a report of A/Prof Ghahreman to

Dr Khashairar Shekarchi dated 27 May 2022 which will also be discussed further below. 8. In respect to the records following injury the applicant's general practitioner (GP), Dr Bahareh Shafaei, whom the applicant appears to have first consulted on 24 August 2023 records in the clinical record of that consultation that whilst there was a prior history of back pain there had been no back issues for the last three years. 9. A/Prof Ghahreman who had treated the applicant in respect to her 2021 neck injury records in his report of 19 December 2023 that the applicant had made a full recovery from her previous spinal injuries by the time of the subject accident. 10. Whilst there is a lacuna in the medical evidence I accept the applicant's evidence, which is consistent with the available clinical records, and am reasonably satisfied[3] that she had recovered from her prior neck and lower back injuries and was asymptomatic prior to sustaining the accepted injuries on 27 July 2023. 11. Mr McManamey submitted on behalf of the applicant that a comparative review of the MRI scans of the cervical spine performed after 27 July 2023 with those performed following the fall in 2021 and before 27 July 2023 reveals a worsening of the pathology at the C5/6 level. 12. On 1 October 2021 Dr Theresa Lee reported on an MRI of the cervical spine[4] relevantly observing at the C5/6 level a shallow diffuse disc bulge with a left central foraminal disc protrusion and left uncovertebral osteophyte. This the doctor observed resulted in severe left foraminal narrowing with "possible irritation" of the left C6 nerve root. The doctor noted a correlation with radicular symptoms was suggested. 13. On 30 September 2023 Dr Prasad Kundum reported on MRI scans of the lumbar and cervical spine.[5] In respect to the cervical spine Dr Kundum observed at the C5/6 level a mild diffuse disc bulge with left paracentral osteophyte disc complex extending to the left neural exit foramen "causing impingement" of the exiting left C6 nerve root. 14. I agree with and accept the submission of Mr McManamey that the MRI scan performed after the accident on 27 July 2023 shows a worsening of the pathology at the C5/6 level. Whilst

Dr Lee on 1 October 2021 had observed and reported "possible irritation" of the left C6 nerve root Dr Kundum following the subject accident on 27 July 2023 reports "impingement" of the exiting left C6 nerve root. 15. That there had been a worsening in the pathology is supported in my view by the opinion and report of A/Prof Ghahreman of 19 December 2023.[6] A/Prof Ghahreman on 19 December 2023 noted the findings of the MRI scan in respect to the left C6 root compression and observed that the symptoms were in keeping with left C6 radiculopathy and axial cervical pain. In respect to the symptoms A/Prof Ghahreman recorded that the applicant complained of neck pain radiating to the shoulders. However, on the left side the applicant had "significant" pain radiating down the arm and elbow with "significant" associated paraesthesia in the left hand, index finger and thumb. 16. The left upper limb symptoms recorded by A/Prof Ghahreman on 19 December 2023 are significantly worse than those recorded by him on 27 May 2022 at which time the doctor was treating the applicant in respect to her 2021 neck injury. On 27 May 2022 A/Prof Ghahreman reported that the applicant had left sided arm pain which fluctuated intermittently with some occasional paraesthesia in the thumb and index finger not as would be reported on

19 December 2023 "significant" pain and paraesthesia. 17. That the applicant suffered from neck and left arm symptoms following the accident is confirmed by the clinical record of Dr Shafaei dated 24 August 2023 in which the doctor recorded a history of the accident on 27 July 2023, that the applicant was suffering from neck pain with radiculopathy, left shoulder and arm pain with weakness of the left arm noted on examination. 18. On 19 December 2023 A/Prof Ghahreman recommended in respect to the cervical spine a left C6 periradicular injection. 19. The recommended injection was performed without benefit with A/Prof Ghahreman reporting to Dr Shafaei on 4 March 2024[7] that the applicant was suffering from unremitting left cervical C6 radiculopathy secondary to discovertebral extrusion and foraminal stenosis at C5/6. 20. A/Prof Ghahreman also reported that the applicant continued to have "immense pain" involving her cervical spine and left upper limb in spite of transforaminal injection. She also had numbness and tingling in her fingers and severe paraesthesia in C6 distribution. 21. In view of lack of response to conservative management A/Prof Ghahreman offered the applicant the anterior cervical discectomy and fusion at C5/6. A/Prof Ghahreman when reporting on the recommendation observed that the operation has a 90% chance of success in reducing or eliminating the symptoms of pain and that with time, radicular symptoms of numbness and weakness may improve (presumably this depends on whether there has been permanent damage to the nerve). The doctor also noted the risks associated with the procedure. 22. Dr Peter Khong, neurosurgeon and spine surgeon, has provided two expert medical forensic reports to the applicant. In his initial report of 25 June 2025[8] Dr Khong reported a diagnosis of neck pain and bilateral arm pain worse on the left due to musculoligamentous strain and exacerbation of previously asymptomatic degenerative changes in the cervical spine as a direct result of the subject car accident. Dr Khong observed that MRI scanning of the cervical spine demonstrated left C5/6 foraminal stenosis with left C6 nerve compression which is the likely cause of the left arm pain. 23. The diagnosis of Dr Khong is similar to and consistent with that of A/Prof Ghahreman. 24. In the opinion of Dr Khong, the C5/6 anterior cervical discectomy and fusion recommended by A/Prof Ghahreman is reasonably necessary. Dr Khong observed that the aim of the surgery would be to decompress the left C6 nerve root, helping with her left sided arm pain and it may also help with her neck pain. The doctor in providing his opinion observed that the applicant had only gained a transient improvement from the left C6 perineural injection and all non-operative management options had failed. 25. Dr Khong in a supplementary report dated 16 September 2025[9] reported that an MRI scan of the cervical spine demonstrated clear left sided C5/6 stenosis causing left C6 nerve root compression which is the likely cause of the left sided neck and arm pain. Dr Khong is of the opinion that the subject accident on 27 July 2023 caused a severe exacerbation of the previously asymptomatic degenerative change in the cervical spine with possible acute annular tear in the left C5/6 disc which was directly caused by the accident. 26. The applicant obtained a second treating specialist opinion from Dr Ashraf Dower, neurosurgeon and spine surgeon, who reported to Dr Shafaei on 19 August 2025[10] that the applicant presented with chronic neck and bilateral upper limb pain, worse on the left since the subject accident on 27 July 2023. The doctor observed that an MRI scan of the cervical spine demonstrated a C5/6 left-sided disc herniation causing foraminal stenosis and impinging the exiting nerve root. Given the applicant's failed conservative treatment and imaging findings Dr Dower recommended C5/6 anterior cervical disc fusion. 27. The applicant observed that Dr Dower unlike Dr Khong had simply been asked generally for an opinion, not an opinion as to the particular treatments recommended by A/Prof Ghahreman, and Dr Dower had independently come to the same conclusions in respect to treatment. 28. In the respondent's submission there is a significant deterioration in the applicant's cervical spine condition when comparing the 30 September 2023 MRI scans with those of

1 April 2025 and that is what, in the respondent's submission, the proposed surgery is going to treat. 29. I am unsure as to the significant deterioration which the respondent is referring to as relevantly the reports for both sets of MRI scans refer to there being "impingement" of the C6 nerve root. In any event the recommendation for the proposed surgery was made by

Dr Ghahreman on 4 March 2024, over a year prior to the 2025 MRI scans being performed. I therefore do not accept the respondent's submission. 30. In the respondent's submission Dr Khong, Dr Ghahreman and Dr Dower do not explain what the proposed surgery to the cervical spine is going to treat and why it is necessary. I do not accept the respondent's submission. 31. It is clear from A/Prof Ghahreman's reports that he is recommending the anterior cervical discectomy and fusion at C5/6 surgery to treat left cervical C6 radiculopathy which is secondary to discovertebral extrusion and foraminal stenosis at C5/6. In making the recommendation the doctor referred directly to the fact that the condition had been unresponsive to transforaminal injection. The doctor clearly identifies the goals of the surgery as pain reduction with also hope for improvement in the radicular symptoms of numbness and weakness. 32. Similarly, Dr Khong has identified the compression of the C6 nerve as the likely cause of the left arm pain and states that the aim of the surgery would be to decompress the left C6 nerve root, helping with her left sided arm pain and it may also help with the neck pain. Dr Khong, like A/Prof Ghahreman in providing his opinion observed that the applicant had only gained a transient improvement from the left C6 perineural injection. 33. Dr Dower is clearly of the same opinion as A/Prof Ghahreman and Dr Khong as in his report of 19 August 2025 he noted that conservative treatment had failed and the imaging findings when recommending the surgery. 34. The respondent relies upon the forensic expert opinion of A/Prof Craig Waller, orthopaedic surgeon. A/Prof Waller initially reported on the applicant on 11 June 2024[11] stating that in his opinion that anterior cervical discectomy and fusion surgery is not reasonably necessary for the injury sustained on 27 July 2023. 35. In coming to this opinion, A/Prof Waller diagnosed a temporary aggravation of pre-existing cervical and lumbar disc disease and spondylosis due to injury on 27 July 2023. Significantly A/Prof Waller only appears to have had access to the cervical MRI scan report of

30 September 2023 and not the results of the scan performed prior to the subject accident. A/Prof Waller also does not explain his reasoning in concluding that the aggravation has ceased, especially in circumstances where there have been continuous and ongoing complaints of neck and upper limb symptoms. 36. In a supplementary report of 8 July 2024[12] A/Prof Waller reported that in his opinion there is no clinical or radiological evidence that the applicant sustained a significant injury to her cervical spine in the subject incident on 27 July 2023. In A/Prof Waller's opinion the MRI scans of the cervical spine show chronic changes of disc degeneration and spondylosis and in his view the applicant did not sustain a significant injury to the cervical spine but rather minor soft tissue injuries which should have settled within weeks. There is again however no indication that the doctor had reviewed the MRI scan performed of the cervical spine prior to 27 July 2023. 37. A/Prof Waller was also of the opinion that there was no verifiable radiculopathy and therefore anterior cervical discectomy and fusion is not reasonably necessary for injuries sustained on 27 July 2023. 38. A/Prof Waller in his final report of 1 September 2025[13] noted that further MRI scans had been performed of the cervical spine however they were not available to him. The doctor maintained his opinion that the ongoing symptoms are due to pre-existing cervical disc degeneration and spondylosis. In the doctor's opinion the upper limb pain does not conform to any dermatomes and the applicant displayed abnormal illness behaviour with symptom amplification and catastrophisation, and very likely central sensitisation. 39. I agree with the applicant's submission that the opinion of A/Prof Waller's that the applicant just sustained minor temporary soft tissue injury to the cervical spine is inconsistent with the history where the applicant has had over two years of constant unremitting pain and neurological symptoms. Whilst Dr Waller reports that he did not find verifiable radiculopathy A/Prof Ghahreman, Dr Dower and Dr Khong are all of the view that impingement of the C6 nerve is a pain and symptom generator. Not only that Dr Dower and A/Prof Ghahreman as treating surgeons are willing to recommend surgery based on that diagnosis. 40. A/Prof Ghahreman as the treating specialist is in my view the best placed to provide an opinion. A/Prof Ghahreman has had the opportunity to review and examine the applicant on a number of occasions as well as having the opportunity to direct the applicant's treatment. A/Prof Ghahreman also had the opportunity to examine and treat the applicant prior to the injury on 27 July 2023 having treated the applicant in respect to her fall in 2021. 41. For the above reasons, in respect to the injury to the cervical spine and the proposed C5/6 anterior cervical discectomy and fusion surgery, I prefer and accept the opinions of A/Prof Ghahreman, Dr Khong and Dr Dower. 42. Applying the commonsense test of causation I am of the view and find for the above reasons that the need for the treatment of the cervical spine is 'as a result of' the accepted injury sustained on 27 July 2023. 43. Section 60 of the 1987 Act requires that the treatment is "reasonably necessary" as a result of injury. 44. Burke CCJ considered the expression "reasonably necessary", then appearing in s 10 of the Workers Compensation Act 1926 (1926 Act) relating to treatment expenses, in some detail in Rose v Health Commission (NSW) [1986] NSWCC 2; (1986) 2 NSWCCR 32 (Rose) stating at [42]:

"Treatment, in the medical or therapeutic context, relates to the management of disease, illness or injury by the provision of medication, surgery or other medical service designed to arrest or abate the progress of the condition or to alleviate, cure or remedy the condition. It is the provision of such services for the purpose of limiting the deleterious effects of a condition and restoring health. If the particular 'treatment' cannot, in reason, be found to have that purpose or be competent to achieve that purpose, then it is certainly not reasonable treatment of the condition and is really not treatment at all. In that sense, an employer can only be liable for the cost of reasonable treatment."

1. The "reasonably necessary" test was also considered in Bartolo v Western Sydney Area Health Service [1997] NSWCC 1; (1997) 14 NSWCCR 233 (Bartolo). In Bartolo, Burke CCJ described the test of "reasonably necessary" as follows:

"The question is should the patient have this treatment or not. If it is better that he have it, then it is necessary and should not be forborne. If in reason it should be said that the patient should not do without this treatment, then it satisfies the test of being reasonably necessary."

"In determining whether a particular regimen is medical treatment and whether it is reasonably necessary that such be afforded to a worker and that such necessity results from injury, it appears to me some general principles can be stated:

1. Prima facie, if the treatment falls within the definition of medical treatment in section 10(2) [the 1926 Act], it is relevant medical treatment for the purposes of this Act. Broadly then, treatment that is given by, or at the direction of, a medical practitioner or consists of the supply of medicines or medical supplies is such treatment.
2. However, though falling within that ambit and thereby presumed reasonable, that presumption is rebuttable (and there would be an evidentiary onus on the party seeking to do so). If it be shown that the particular treatment afforded is not appropriate, is not competent to alleviate the effects of injury, then it is not relevant treatment for the purposes of the Act.
3. Any necessity for relevant treatment results from the injury where its purpose and potential effect is to alleviate the consequences of injury.
4. It is reasonably necessary that such treatment be afforded a worker if this Court concludes, exercising prudence, sound judgment and good sense, that it is so. That involves the Court in deciding, on the facts as it finds them, that the particular treatment is essential to, should be afforded to, and should not be forborne by, the worker.
5. In so deciding, the Court will have regard to medical opinion as to the relevance and appropriateness of the particular treatment, any available alternative treatment, the cost factor, the actual or potential effectiveness of the treatment and its place in the usual medical armoury of treatments for the particular condition."
6. The legal test to be applied when determining whether proposed treatment is reasonably necessary as a result of a workplace injury as required by s 60 of the 1987 Act was considered by Roche DP in Diab v NRMA Limited [2014] NSWWCCPD 72 (Diab) where stated at [86]:

"Reasonably necessary does not mean 'absolutely necessary' (Moorebank at [154]). If something is 'necessary', in the sense of indispensable, it will be 'reasonably necessary'. That is because reasonably necessary is a lesser requirement than 'necessary'. Depending on the circumstances, a range of different treatments may qualify as 'reasonably necessary' and a worker only has to establish that the treatment claimed is one of those treatments. A worker certainly does not have to establish that the treatment is 'reasonable and necessary', which is a significantly more demanding test that many insurers and doctors apply."

1. In Diab Deputy President Roche cited the decision of Burke CCJ in Rose with approval and stated:

"[88] In the context of s 60, the relevant matters, according to the criteria of reasonableness, include, but are not necessarily limited to, the matters noted by Burke CCJ at point (5) in Rose......namely:

(a) the appropriateness of the particular treatment;

(b) the availability of alternative treatment, and its potential effectiveness;

(c) the cost of the treatment;

(d) the actual or potential effectiveness of the treatment, and

(e) the acceptance by medical experts of the treatment as being appropriate and likely to be effective.

[89] With respect to point (d), it should be noted that while the effectiveness of the treatment is relevant to whether the treatment was reasonably necessary, it is certainly not determinative. The evidence may show that the same outcome could be achieved by a different treatment, but at a much lower cost. Similarly, bearing in mind that all treatment, especially surgery, carries a risk of a less than ideal result, a poor outcome does not necessarily mean that the treatment was not reasonably necessary. As always, each case will depend on its facts.

[90] While the above matters are 'useful heads for consideration', the 'essential question remains whether the treatment was reasonably necessary' (Margaroff v Cordon Bleu Cookware Pty Ltd [1997] NSWCC 13; (1997) 15 NSWCCR 204 at 208C). Thus, it is not simply a matter of asking, as was suggested in Bartolo, is it better that the worker have the treatment or not. As noted by French CJ and Gummow J at [58] in Spencer v Commonwealth of Australia [2010] HCA 28, when dealing with how the expression 'no reasonable prospect' should be understood, '[n]o paraphrase of the expression can be adopted as a sufficient explanation of its operation, let alone definition of its content'."

1. Turning to a consideration of the relevant matters according to the criteria of reasonableness identified by Roche DP in Diab. In my view the proposed anterior cervical discectomy and fusion surgery at C5/6 is appropriate. The treatment is appropriate in the opinion of A/Prof Ghahreman and Dr Khong, opinions which I have previously accepted. Both A/Prof Ghahreman and Dr Khong provide their reasons for their support of the surgery which includes what the surgery is to treat and the potential benefits of the surgery including reduced neck and arm pain and reduction in radicular symptoms. There is no alternative treatment identified, and all alternate conservative treatment has failed including spinal injection. The cost of the treatment is not unusual, and the costs of similar surgical procedures are regular paid for under workers compensation. In respect to the potential effectiveness of the surgery A/Prof Ghahreman has observed that the operation has a 90% chance of success in reducing or eliminating the symptoms of pain and that with time, radicular symptoms of numbness and weakness may also improve. The proposed surgery is an accepted form of treatment.
2. I am of the view that the factors identified in Diab weigh in favour of the proposed anterior cervical discectomy and fusion surgery at C5/6 being "reasonably necessary".
3. For the above reasons I find that the anterior cervical discectomy and fusion surgery at C5/6 is reasonably necessary as a result of the accepted injury sustained by the applicant on

27 July 2023. 4. In respect to the lumbar spine, I have previously found that the applicant had recovered from any prior injuries and that her lower back was asymptomatic prior to the subject injury on

27 July 2023. 5. A/Prof Ghahreman reported to Dr Shafaei on 19 December 2023 that the applicant had become symptomatic as a result of the subject work accident. A/Prof Ghahreman reported that the applicant was suffering from back pain with radiation to the paraspinous muscles in the lumbar region as well as pain radiating to the right buttock and thigh to the shin and causing paraesthesia in the right leg and foot. A/Prof Ghahreman noted the results of the MRI scan which included low grade contact with exiting L5 nerve roots. The doctor recommended bilateral L4/5 and L5/S1 facet injections. 6. A/Prof Ghahreman reported to Dr Shafaei on 4 March 2024[14] that the applicant had significant ongoing lower back pain and bilateral lower limb pain (right side significantly worse than left). The doctor observed that the applicant's symptoms had not shown durable response to spinal injections, presumably the bilateral L4/5 and L5/S1 facet injections recommended by the doctor on 19 December 2023. A/Prof Ghahreman observed that the applicant had significant ongoing right S1 radiculopathy. 7. In view of lack of response to conservative management, including spinal injections, A/Prof Ghahreman offered the applicant lumbar microdiscectomy at L5/S1 on the right side. In recommending the surgery the doctor observed that surgery is appropriate when the pain is severe and unremitting or has persisted beyond an acceptable time frame for the spontaneous recovery. The doctor observed that decompressive surgery has a 90% chance of significantly improving or resolving radicular pain and may also improve or resolve lower back pain. 8. On 25 June 2025 Dr Khong reported that the applicant complained of band-like mid lumbar spine pain which radiated down the right buttock, posterior thigh and calf to the bottom of the foot to the toes. She also on occasion experienced pain in the anterolateral thighs bilaterally. 9. Dr Khong noted that bilateral L4/5 and L5/S1 facet joint injections provided 20% relief for a week. 10. Dr Khong diagnosed lower back pain and right leg pain due to musculoligamentous strain and exacerbation of previously asymptomatic degenerative changes in the lumbar spine as a direct result of the subject car accident on 27 July 2023. The doctor observed that MRI scans of the lumbar spine demonstrated possible contact between the right L5/S1 disc and the right S1 nerve root, which in the doctor's opinion may be the cause of the right leg pain. 11. Dr Khong observed that non-operative treatment had failed and that bilateral lumbar and SIJ blocks are low risk and may help with the lower back pain in the short to medium term. In the doctor's opinion these blocks are reasonably necessary and may be of benefit. 12. Dr Khong in supporting the blocks was supporting the treatment recommendation of

Dr Sushama Deshpande, interventional pain specialist, who on 9 April 2025 sought approval for bilateral lumbar and SIJ blocks. In seeking approval for the blocks Dr Deshpande had simply reported that the aim was "to reduce the pain and improve the function."[15]

Mr McManamey submitted that at that stage Dr Khong had not been asked for an opinion in respect to the lumbar surgery proposed by A/Prof Ghahreman. 13. In his supplementary report of 16 September 2025 Dr Khong was asked to comment on the right sided lumbar microdiscectomy at L5/S1 recommended by A/Prof Ghahreman. In the opinion of Dr Khong, the proposed surgery is reasonably necessary. In providing his opinion Dr Khong again observed that the applicant had band-like lower back pain with radiation down the right buttock, posterior thigh and calf to the bottom of the foot since the subject accident on 27 July 2023. 14. In Dr Khong's opinion the MRI scans demonstrate right L5/S1 lateral recess stenosis with contact with the right S1 nerve root which is the likely cause of the radicular pain with the dermatomal pattern being consistent with the S1 nerve. The doctor observed that the applicant had trialled analgesia and physiotherapy. In the doctor's opinion a right S1 perineural injection was unlikely to give long term pain relief as the pain had been present for over two years. The doctor reasoned that the aim of a right L5/S1 microdiscectomy would be to decompress the right S1 nerve root which has at least an 80% chance of improving the right lower limb pain. 15. In the opinion of Dr Khong, the subject accident on 27 July 2023 caused an exacerbation of previously asymptomatic degenerative changes in the lumbar spine with a possible acute right sided annular tear in the right L5/S1 disc which was directly caused by the accident. 16. Dr Dower reported to Dr Shafaei on 19 August 2025[16] that the applicant presented with severe lower back pain which radiates down her right leg, posteriorly into the thigh and leg, occasionally extending to the foot. Noting the MRI scan results and given that conservative treatment had failed Dr Dower also recommended a right-sided L5/S1 discectomy. 17. The respondent relies on the opinion of A/Prof Waller who reporting on 11 June 2024 noted that the applicant had undergone six cortisone injections into her lumbar spine without relief of symptoms. A/Prof Waller diagnosed a temporary and resolved aggravation of pre-existing lumbar disc disease and spondylosis due to injury on 27 July 2023. In the opinion of A/Prof Waller the lumbar microdiscectomy is not reasonably necessary for the injury sustained at work on 27 July 2023. 18. On 8 July 2024 A/Prof Waller reported that in his opinion there is no clinical or radiological evidence that the applicant had sustained a significant injury to her lumbar spine on

27 July 2023. In the doctors view the MRI scans showed predominantly chronic degenerative changes. The doctor confirmed his previous opinion that the applicant had sustained a soft tissue injury which should have settled within weeks. The doctor also reported that there were no verifiable radiculopathy and therefore discectomy is not reasonably necessary for injuries sustained on 27 July 2023. A/Prof Waller again confirmed his opinion in his final report of 1 September 2025. 19. I agree with and accept the submission of Mr McManamey on behalf of the applicant that A/Prof Waller's opinion that the applicant sustained minor soft tissue injuries on 27 July 2023 which have resolved is inconsistent with the history and evidence. 20. I have previously found that the applicant had recovered from her previous lumbar spine injuries and that her low back was asymptomatic prior to sustaining injury on 27 July 2023. The applicant has remained symptomatic since sustaining injury on 27 July 2023 with ongoing back and lower limb symptoms. A/Prof Waller provides no reasoning for his opinion that the applicant has recovered from any injury sustained on 27 July 2023 given the history of unremitting and unresolving symptomatology. 21. Whilst Dr Waller reports that he has not found radiculopathy the doctor's opinion is the odd one out. Dr Khong, A/Prof Ghahreman and Dr Dower are all of the opinion that the S1 nerve is the pain generator and that this is largely consistent with the results of the MRI imaging. I do not accept the respondent's submission that Dr Khong, A/Prof Ghahreman and Dr Dower do not identify what pathology the surgery is to treat and what effect the surgery is hoped to have. The doctors are clear in their opinions that the surgery is to decompress the S1 nerve and treat the symptoms in particular the right lower limb symptoms arising from the compression or entrapment of the right S1 nerve. 22. For the above reasons I prefer the opinions of A/Prof Ghahreman, Dr Khong and Dr Dower to that of A/Prof Waller. 23. Turning to a consideration of the relevant matters according to the criteria of reasonableness identified by Roche DP in Diab. In my view the proposed L5/S1 right sided microdiscectomy surgery is appropriate. The treatment is appropriate in the opinion of A/Prof Ghahreman,

Dr Khong and Dr Dower, opinions which I have previously accepted. A/Prof Ghahreman,

Dr Khong and Dr Dower provide their reasons for their support of the surgery which includes what the surgery is to treat and the potential benefits of the surgery including reduced pain. Alternative conservative treatment has so far failed and bilateral lumbar and SIJ blocks are only likely to provide temporary relief. The test is whether the treatment is reasonably necessary and the applicant is not required to exhaust all forms of alternative treatment prior to the surgical option becoming reasonably necessary. The cost of the treatment is not unusual, and the costs of similar surgical procedures are regular paid for under workers compensation. In respect to the potential effectiveness of the surgery Dr Khong has assessed at least an 80% chance of improving the right lower limb pain. The proposed surgery is an accepted form of treatment. 24. I am of the view that the factors identified in Diab weigh in favour of the proposed L5/S1 right sided microdiscectomy surgery being "reasonably necessary". 25. In respect to the bilateral lumbar and SIJ blocks Dr Khong observed that it was hoped that they would give short to medium term relief and that they were unlikely to give long term relief and therefore appear to be only a temporary treatment in circumstances where the applicant wishes to undergo surgery. Mr McManamey submitted on behalf of the applicant that the blocks may have some function whilst the applicant awaits the lumbar spine surgery with the cervical spine surgery likely to be performed first, however there is no evidence as to the likely order of the surgeries. 26. For the above reasons I am of the view and find that the L5/S1 right sided microdiscectomy surgery recommended by A/Prof Ghahreman is reasonably necessary as a result of the accepted injury sustained on 27 July 2023. I am not however of the view that the bilateral lumbar and SIJ blocks are reasonably necessary as a result of the injury.

[1] Murphy v Allity Management Services Pty Ltd [2015] NSWWCCPD 49 (Murphy).

[3] Briginshaw v Briginshaw [1938] HCA 34; 60 CLR 336 (Briginshaw).