Spine and Pelvis

Spine

The AMA Guides offers two methods for spinal impairment rating: the diagnosis-related estimate (DRE) method and the range of motion (ROM) method. The ROM technique is laborious and, for the earlier mentioned reason of avoiding duplication, will not be reproduced here. The AMA Guides method is synopsized in Tables 8-1 (cervical spine), 8-2 (thoracic spine), and 8-3 (lumbar spine).

However, an alternative diagnosis-based estimate (DBE) method does exist that is both simple and comprehensive. Wiesel et al. (1,2) have placed the impairment ratings for common spinal conditions within the framework of job occupation requirements as described in the Dictionary of Occupational Titles published by the U.S. Department of Labor. This method has been adapted in Tables 8-4 (lumbar spine) and 8-5 (cervical spine).

Thus, the examiner is still offered two options for rating spinal impairments. One method is a modification of the simpler of those offered by the AMA Guides, with which most disability examining physicians have some familiarity. The other is Wiesel’s, which, although not having achieved widespread recognition in orthopaedic and musculoskeletal circles, does have a lot going for it in terms of ease of use. The examiner might wish to compare the two and come to his or her own conclusion about which is more advantageous.

This manual does not address spinal cord injury, nerve root injury, or major spinal fractures. In those cases, a neurosurgeon or spine specialist is often involved, and practitioners of those specialties or a specialist in impairment evaluations, such as a member of the American Association of Disability Evaluating Physicians, can be called on to supply an impairment rating.

Pelvis

Bony pelvic trauma is rated by the DBE method. For excessive limb shortening (>2.5 cm), the impairment value from Table 8-6 can be combined with that from Table 7-4 on leg length discrepancy.

TABLE 8-1 Cervical Spine

Category I (0% WP)	Category II (5–8% WP)	Category III (15–18% WP)	Category IV (25–28% WP)	Category V (35–38% WP)
No significant objective findings	Objective clinical findings such as spasm, guarding, loss of motion or Herniated disc by abnormal imaging study with resolved radiculopathy or Fractures: <25% compression fracture or uncomplicated spinous process, transverse process, or posterior element fracture	Significant radiculopathy; EMG abnormalities plus positive physical signs such as atrophy, or loss of strength or reflex or Herniated disc by abnormal imaging study with radiculopathy by EMG or individuals who have had surgery and are improved or Fractures: 25–50% compression fracture or posterior element fracture with displacement	1. Bilateral or multilevel radiculopathy or 2. Surgical fusion, successful or unsuccessful or 3. Alteration of motion segment instability: ≥3.5 mm or >11° translation of adjacent vertebrae on flexion-extension radiographs or Fractures: >50% compression of one vertebra; no neurologic deficit	Significant UE impairment with neurologic loss and requiring external devices or Fractures: with compromised spinal canal, UE sensory deficits, but without LE involvement
WP, whole person; EMG, electromyographic; UE, upper extremity; LE, lower extremity. Adapted from Cocchiarella L, Anderson GBJ, eds. Guides to the Evaluation of Permanent Impairment. 5th ed. Chicago: American Medical Association; 2001:392.