Search for other papers by Christopher R. Brigham in
Current site
Google Scholar
PubMed
Search for other papers by James Talmage in
Current site
Google Scholar
PubMed
Search for other papers by Marjorie Eskay-Auerbach in
Current site
Google Scholar
PubMed
Search for other papers by Charles McGhee in
Current site
Google Scholar
PubMed
Abstract
This Case Example illustrates common questions associated with the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, including the selection of appropriate methodology and the issue of whether spinal injections are considered to be ratable events. A 32-year-old male worker in California sustained a work-related low back injury and was examined by a chiropractic Qualified Medical Examiner (QME). The patient was referred for magnetic resonance imaging, which showed multiple lumbar disk protrusions and an L4-5 annular fissure. An epidural steroid injection at L5-S1 was of limited benefit, but bilateral L4-5 and L5-S1 facet injections, followed by chiropractic care, precluded any need for medial branch blocks or a facet rhizotomy. On presentation to the QME, the individual reported experiencing low back pain 10% of the time; this was rated 3/10 and was localized around the lumbar and lumbosacral region and was exacerbated with prolonged sitting or playing sports. The evaluator provided a rating of the lumbar spine using the range of motion (ROM) method, but the AMA Guides, Fifth Edition, states that the Diagnosis-related estimate (DRE) must be used because the impairment is due to an injury. The article demonstrates in detail how the DRE method would be applied in this case. The performance of epidural and facet injections does not constitute a ratable surgical event because these are not intradiscal injections intended to produce permanent anatomic changes in the disk.
-
2.
Battié MC, Videman T, Parent E. Lumbar disc degeneration. Spine. 2004;29(23):2679–2690
-
3.
Armon C, Argoff CE, Samuels J, et al. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007;68;723-729.
-
4.
Chou, R, Atlas SJ, Stanon SP, et al. Spine. 2009;34(10):1078-1093.
-
5.
Chou R, Baisden J, Carragee EJ, et al. Spine. 2009;34(10):1094-1109.
-
6.
Endean A, Palmer KT, Coggon D. Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemio-logic studies: a systematic review. Spine. 2011;36(2):160-169.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 628 | 628 | 155 |
| Full Text Views | 32 | 32 | 0 |
| PDF Downloads | 0 | 0 | 0 |
