This article continues the discussion from the previous issue regarding common impairment rating scenarios for individuals who have had back surgery: Scenario 6) What is the impairment rating for an individual who has had a spinal fusion operation? 7) What is the impairment rating for an individual who has pre-existing spondylolisthesis, has a back strain injury, and undergoes a spinal fusion operation? 8) What is the impairment rating of an individual with spinal fracture(s) who has been treated by spinal fusion? 9) What about surgical complications? The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes that, following the Injury Model, surgery to treat an impairment does not modify the original impairment estimate. Major postoperative complications such as myocardial infarction and deep venous thrombosis are covered by most workers’ compensation systems; thus they should be rated, and the rating should be combined with the rating for the injury. The article discusses ratings for arachnoiditis; discitis; bowel, bladder, and sexual impairment; pseudarthrosis following attempted fusion; and chronic pain syndrome (note that it is never appropriate to rate an individual for both a spinal injury and chronic pain syndrome). The AMA Guides recognizes that rating spinal impairment is challenging and may change over time.