56 Dr Pattinson re-examined him on 9 September 2002. He was complaining of on-going back pain, and had only been able to work as a casual since the time of injury. He had been having physiotherapy. Mr Morgan said that he was unable to jump off small heights, and that lifting and bending caused back pain. He was taking Panadeine Forte and Viox, and having difficulty getting full time work. On examination, spinal alignment was normal; there was a good range of motion and no tenderness. X-rays showed no deterioration in position. Dr Pattinson thought that the main problem was pain control, and that surgery was not indicated. He referred him to the pain clinic at St George hospital on 9 September 2002.
57 Following that referral, on 11 September 2002, Dr Vasic, pain management specialist, reported that Mr Morgan described pain in his lower thoracic spine on both sides, though the left side was worse than the right. While seated he rated it at 3½ out of 10, and at its worst 7 out of 10. There were no neuropathic features. Mr Morgan described difficulties in going to sleep, that he often woke in pain, and that household activities such as washing up and vacuuming exacerbated the pain, so that he was unable to do housework effectively. He was taking Panadeine Forte, two per day. Tramadol was not proving of benefit, nor Viox. He was having physiotherapy weekly. It was concluded that he was suffering chronic pain secondary to vertebral fractures occurring two years earlier, and that the pain should eventually improve. He had continued working as a carpenter, but casually, and using medication to get through his work.
58 On 3 February 2003, Dr Pattinson thought that the prognosis was guarded as it was nearly three years since the initial injury and the on-going back pain continued, interfering with his ability to work as carpenter. He thought that Mr Morgan was unfit to work full time as a carpenter, due to on-going pain related to the compression fractures of T12 and L1. He thought Mr Morgan had a 20% permanent loss of function of the lumbar spine.
59 On 18 February 2003 Dr Nigro reported that Mr Morgan remained unfit for pre-injury (or any) duties, and that the prognosis was poor, as recovery had not occurred since the fall nearly three years earlier.
60 Kevin Hewson, physiotherapist, reported that Mr Morgan had chronic thoracolumbar spine pain, and that he had seen how heavy work and bending could re-aggravate his condition. He thought Mr Morgan may continue to have pain and restricted activities into the foreseeable future, and doubted that there would be complete resolution in the next few years. He recommended that he avoid any work involving lifting or repetitive bending, as that may aggravate his condition.
61 The radiological evidence confirms a spinal injury. While a lumbar spine x-ray on 6 March 2000 showed minimal thoracolumbar scoliosis, with no definite fracture detected, a lumbar spine CT scan on 20 March 2000 showed mild symmetrical posterior disc bulge at L4/5 which slightly indented the thecal sac with mild foraminal narrowing at each side, and also a minimal posterior disc bulge at L5/S1 with some minor osteoarthritic changes L3/4, L4/5, L5/S1; and a thoracolumbar spine x-ray on 15 May 2000 showed some anterior wedging in the low thoracic and upper lumbar spine and evidence of trauma to the superior end plate of T12/L1.
62 Dr Mahony, orthopaedic surgeon, examined Mr Morgan on 24 June 2003. He noted that Mr Morgan had been treated with a Taylor's brace and was off work about 12 months. He recorded that he had subsequently tried to work on several occasions and in the last three years had worked about six months on separate occasions, and that he had required and was still attending for physiotherapy, and complained of persisting symptoms. His present complaints included pain in the back (indicating the lumbar area) associated with a numb feeling in the left thigh; a "tired" feeling in the left leg; occasional soreness of the neck; pain behind the left elbow; and cessation of scuba diving, tennis and golf and motor cycle riding. On examination, flexion of the neck was within normal limits, but there was guarding. Shoulder movements were within normal limits. Spinal movements were possible in flexion, with fingertips reaching to the mid tibial level. Extension and lateral flexion appeared restricted in extremes but rotation was within normal limits. Straight leg raising was possible to about 60 degrees on both sides. Dr Mahony concluded that Mr Morgan had developed symptoms referrable to a cervical strain with nerve root irritation radiating to the posterior aspects of the shoulders. He had also sustained compression fractures of T12 and less so L1, with evidence of discogenic lesions at L4/5 and lumbosacral levels. He considered that the numbness of the outer aspect of the left thigh was associated with tension in the low discs. He recommended that future activities not involve significant bending or lifting, and that it would not be wise to return to carpentry. After allowing for pre-existing changes, he thought that Mr Morgan had a 5% permanent impairment of the neck, 2.5% loss of efficient use of the right upper limb at and above the elbow, 12.5% permanent loss of efficient use of the left upper limb at and above the elbow, 10% permanent impairment of the left upper limb as a result of the left olecranon bursitis, 30% permanent impairment of the back, and 5% permanent loss of efficient use of the left lower limb at and above the knee. In oral evidence, Dr Mahony explained that headaches, of which Mr Morgan complained after the accident but which were not present beforehand, were frequently referred from the neck. He confirmed that there was a likelihood of accelerated arthritic change as a consequence of his injuries. He thought improvement was unlikely, although following correct medical advice might lessen the symptoms. The film evidence of Mr Morgan at work on 11 and 14 February 2005, when he worked two or three hours each morning, did not affect his opinion that it would be unwise for him to return to carpentry duties.
63 Dr Bleasel, neurosurgeon, saw Mr Morgan on 3 August 2005. Mr Morgan complained of intermittent depression, neck pain mainly on the left side, frontal headaches sometimes occipital, low thoracic pain, low back pain (he could not bend) and his legs feeling weak with severe cramps in the calves, particularly the left. On examination there was neck pain with movement, particularly on the left side, and a restriction of rotation to the right. There was obvious muscle spasm on the left on examination of the lumbar spine. Straight leg raising was achieved to 60 degrees causing back pain, not leg pain. Dr Bleasel concluded that he had vertebral fractures, lower thoracic and upper lumbar, and continuing pain "which is common with this type of fracture". He concluded that he was not fit to return to his original work, and though he did small jobs for friends he could not stand for long or work in a bent position or do any heavy lifting. He thought the prognosis for the future was not good. Dr Bleasel was not required for cross-examination
64 Medical opinion tendered in the Owners' case is that he has been left with a small permanent impairment (5% of thoracolumbar spine function), and a risk of developing premature degenerative disc disease, particularly at T12/L1, but is fit for all forms of employment including his previous employment as a handyman/carpenter full time without any specific restrictions.