Is anyone else concerned about the fact that a first lumbar fusion gets assigned 20%-23% and is based on the diagnosis-related estimates (DRE) method, and if a second fusion happens then the range of motion (ROM) method is used and the person only receives 12%-13%? Is this fair? Will this paradox be dealt with in the Sixth Edition?


This paradox is explored in the article in this issue titled Cervical Fusions: A Paradox in the Fifth Edition. With the ROM method, lumbar impairment is based on the combined impairment from Table 15-7 (5th ed, 407), lumbar motion impairment, and neurological impairment, if any. Most postfusion patients will have motion deficits; therefore, their impairment will not be based solely on Table 15-7.

Assuming that the first fusion is single-level and the second fusion was 2-level, the...

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