Chapter 17, The Spine and Pelvis, of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, is used frequently when determining an individual's permanent impairment rating at maximum medical improvement (MMI). Frequently, ratings for diagnoses of “nonverifiable back pain,” herniated discs, nonverifiable radicular pain, and radiculopathy are requested. Definitions of terminology used in the AMA Guides may differ from those used by some physicians when they see patients, and evaluators should use terminology that is consistent with that of the AMA Guides. For example, for the purposes of the AMA Guides, radiculopathy is defined as “significant alteration in the function of a single or multiple nerve roots and is usually caused by mechanical or chemical irritation of one or several nerves.” This article presents fifteen cases, the whole person impairment associated with each case, and a discussion of the process whereby the rating was obtained. Accurate and fair ratings of common cases of injury-related back and leg pain require a thorough knowledge of the definitions outlined in the AMA Guides, Sixth Edition, as well as thorough knowledge of the peripheral nervous system. Also, an accurate and detailed subjective history of pain reports (including true “radicular” referral patterns) and objective physical examination, as well as a review of the medical records and previous documentations, are essential.

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