Question: How do you recommend rating someone with a T12-L1 fusion after a fall and fracture using the Guides, Fifth Edition. Is it both thoracic and lumbar?

Answer: This is an unusual clinical situation. For a fracture of the superior end plate of L1 some surgeons might do a one level fusion from T12 to L1, but the most common situation is for a minimum of two levels to be fused for a spinal fracture. For a T12 fracture, this would be a T11-L1 fusion; for a L1 fracture, this would be a T12 to L2 fusion.

The general approach to this type of clinical case: consider the rating under the DRE IV lumbar spine since the most common fracture treated by a fusion at this level would be at the T12 level. In the end, since...

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