National Injury Diagnostics
800 Wisconsin St. Bldg. D2, Mailbox 50
Suite 102
Eau Claire WI 54703
Tele: 715-833-8533 Fax: 715-839-7902
info@nationalinjurydiagnostics.com
Represented Present or Past in:
International Chiropractic Association
Washington Chiropractic Association
Wisconsin Chiropractic Association
International Association for the Study of Pain
The Guides At a Glance
The information reported here is out of the A.M.A. Guides to the Evaluation of Permanent Impairment, 5th Edition 2001. We recommend that you obtain and study these guides for yourself. The following is an overview of information that is important for you to understand.
Injuries to the spine can cause both (1) functional loss and (2) structural damage. Functional loss is the resultant effect of the injury on normal body systems and their ability to optimally function. These include but are not limited to: muscular strength, joint mobility, coordination, and sensory perception. Structural damage includes the fracture of bones, dislocation or segmental somatic dysfunction (Subluxation), and the tearing of joint capsules, discs, and other connective tissue. Other connective tissue includes supporting ligaments, tendons, muscles, nerves, and blood vessels.
Demonstrating the effect of spinal injuries is dependant upon the examination performed on the patient, proper utilization of diagnostic protocols, the documentation and interpretation of the findings.
(DRE) Diagnosis Related Estimates Method of Assigning Impairment Rating Based on the AMA Guide to Permanent Impairment, 2000 pp. 373-431.
“The DRE method is the principal methodology used to evaluate an individual who has a distinct injury” (pp. 379)
There are a couple of things that we want you to look at when you are looking at the DRE Tables for Cervical & Lumbar Impairment.
Look over the categories and the Criteria that places a patient in the Category. I will use the Cervical Column to make this point.
Category I. 0% Impairment has No Clinical Signs and No Symptoms No Significant Loss of Motion Segment Integrity
Category II 5%-8% Impairment has Non Verifiable Radicular Pain (No Positive X-Ray, MRI, CT, NCV, EMG, Sep Etc. or herniated disc with radicular symptoms that treat conservatively to a great result. Disc would be verified on MRI or CT or less that 25% compression Fracture, and spinal fractures that do not alter structural integrity as they heal and cause no Radicular sign.
Category III 15%-18% Impairment has Herniated disc that repairs or does not repair with Surgery or Treatment, but the patient had a surgery or 25%-50% vertebral body Compression Fractures, Spinal Fracture with displacement of the spinal cord, that heals without loss of structural integrity and the patient may have ongoing radiculopathy. This patient may have ongoing radicular symptoms verified by positive electro-diagnostic studies
Now bear in mind that we have not even gotten to the Category for loss of motion segment integrity! These guides place heavy emphasis on Loss of Motion Segment Integrity, and give it a much more severe impairment Rating. Now Look at Category IV.
Category IV 25%-28% Impairment " Alteration of motion segment integrity or bilateral or multilevel radiculopathy; alteration of motion segment integrity is defined from flexion extension radiographs as at least 3.5 mm of translation of one vertebra on another, or angular motion of more than 11 degrees greater at each adjacent level" AMA Guides 5th Edition This patient may also have a compression fracture of more than 50% without residual neural compromise.
Remember What Our Own Guidelines State:
The American Medical Association, in its Guides to the Evaluation of Permanent Impairment, lists the following as acceptable means to rate impairment: 70
• Impairment due to loss of muscle power and motor function,
• impairment due to abnormal motion of the spine,
• impairment due to loss of motion segment integrity,
• impairment due to disc problems,
• impairment due to pain or sensory deficit, and segmental instability.
The above are, in fact, components of the Vertebral Subluxation Complex.71,72 2003 CCP Guidelines pg.17
The AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, makes it much easier for the practitioner to logically place a patient and determine the affect their injuries will have on their ability to perform Activities of Daily Living. We have put these in word format so that you can cut and paste for reports if you like. We hope that this helps!
NID
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