Guidelines for the assessment of permanent impairment Version 3

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Chapter 4Spinal ImpairmentIntroduction4.1 The AMA 4 Guides use the terms cervicothoracic, thoracolumbar and lumbosacral for the threespine regions. These terms relate to the cervical, thoracic and lumbar regions respectively.4.2 The spine is discussed in section 3.3 of Chapter 3 in the AMA 4 Guides (pp 94 - 138). That Chapterpresents several methods of assessing impairments of the spine. Only the diagnosis-relatedestimate (DRE) method is to be used for evaluation of impairment of the spine, as modified bythis Chapter. The AMA 4 Guides use the term ‘Injury Model’ for this method.4.3 The “Injury Model” relies especially on evidence of neurological deficits and uncommon, adversestructural changes, such as fractures and dislocations. Under this model, DREs are differentiatedaccording to clinical findings that are verifiable using standard medical procedures.4.4 The assessment of spinal impairment is made at the time a worker is examined, provided themedical assessor is convinced the condition is stable and permanent. If surgery has beenperformed then the effect of the surgery, as well as the structural inclusions, must be taken intoconsideration when making the assessment of impairment. Refer also to 1.20 - 1.22 of theseGuidelines.The Approach to Assessment of the Spine4.5 The Range of Motion (ROM) model is not to be used for spinal impairment evaluation. (Pages112 - 130, AMA 4 Guides, including Table 75 are not to be used).4.6 The medical assessor should start with Table 4.1 of these Guidelines to establish theappropriate category for the spine impairment. Its principal difference from Table 70 (p 108,AMA 4 Guides) is the removal of the term ‘motion segment integrity’ wherever it appears (see4.15 below).WCT Guidelines 1 October 2011 21
Table 4.1 Assessing spinal impairmentPatient’s conditionLow back pain, neck pain [back pain (lumbago), WAD* 1] complaints orsymptomsVertebral body compression, < 25%Low back pain or neck pain with guarding or non-verifiable radicularcomplaints or non-uniform range of motion (dysmetria)Posterior element fracture, healed, stable, no dislocation or radiculopathyTransverse or spinous process fracture with displacement of fragment,healed, stableLow back or neck pain with radiculopathy [WADIII]Vertebral body compression fracture 25-50%Posterior element fracture with spinal canal deformity or radiculopathy,stable, healedRadiculopathyDiagnosis-related estimate categoryI II III IV VIIIIIIIIIIIIIIIIIIIIIVertebral body compression > 50% IV VMulti-level structural compromise IV VSpondylolysis with radiculopathy III IV VSpondylolysis without radiculopathy I IISpondylolisthesis with radiculopathy III IV VVertebral body fracture without radiculopathy II III IVVertebral body fracture with radiculopathy III IV VVertebral body dislocation without radiculopathy II III IVVertebral body dislocation with radiculopathy III IV VPrevious spine operation without radiculopathy II III IVPrevious spine operation with radiculopathy III IV VStenosis, facet arthrosis or disease, or disc arthrosis I IIStenosis, facet arthrosis or disease, or disc arthrosis with radiculopathyIII* Whiplash associated disorder. WAD I: Neck complaint of pain, stiffness or tenderness only. No physical sign(s). WADII: Neck complaint AND musculoskeletal sign(s). Musculoskeletal signs include non-uniform range of motion and pointtenderness. WAD III: Neck complaint AND neurological sign(s). Neurological signs include decreased or absent deeptendon reflexes, weakness and sensory deficits. WAD IV: Neck complaint AND fracture or dislocation. Motor AccidentsAuthority. Update of Quebec Task Force Guidelines for the Management of Whiplash-associated Disorders. January2001: p5. Note: DRE Categories VI, VII and VIII involve spinal cord injuries and should be assessed according to sections4.28 and 4.29 of these GuidelinesAdapted from MAA 2007 Guidelines Table 4.1WCT Guidelines 1 October 2011 22
Page 1 and 2: GUIDELINES FOR THE ASSESSMENT OFPER
Page 3 and 4: ForewordThe Workers Rehabilitation
Page 5 and 6: Table of ContentsPage No.Foreword .
Page 7 and 8: Causation of permanent impairment1.
Page 9 and 10: 1.18 Using these Guidelines and the
Page 11 and 12: Adjustments for Effects of Prosthes
Page 13 and 14: stable and the assessment of perman
Page 15 and 16: 2.8 Although range of motion appear
Page 17 and 18: (ii) Rate the upper extremity impai
Page 19 and 20: 3.7 Use of worksheets is essential.
Page 21 and 22: Table 3.2: Lower Extremity Workshee
Page 23 and 24: Table 3.3. Impairment for ankylosis
Page 25: Table 3.4Tibial Nerve Impairment Va
Page 29 and 30: Specific interpretation of the AMA
Page 31 and 32: Definitions of clinical findings co
Page 33 and 34: 4.22 When allocating the worker to
Page 35 and 36: Sexual Functioning4.30 Sexual dysfu
Page 37 and 38: 4.45 One or more end plate fracture
Page 39 and 40: 5.7 Headache or other pain potentia
Page 41 and 42: Table 5.2Criteria for rating impair
Page 43 and 44: Chapter 6Ear, Nose and Throat, and
Page 45 and 46: Scarring5% for loss of sense of tas
Page 47 and 48: 7.7 In order to measure the impairm
Page 49 and 50: impairment using precisely the meth
Page 51 and 52: Table 7.3TravelClass 1Class 2Class
Page 53 and 54: Table 7.7 Conversion TableClass1Cla
Page 55 and 56: Psychiatric Impairment Rating Scale
Page 57 and 58: 7.21 Examples1. A worker suffers a
Page 59 and 60: Chapter 8Impairment of Other Body S
Page 61 and 62: Pneumoconiosis (AMA 5 Guides, Secti
Page 63 and 64: 8.23 Hypertensive Cardiovascular Di
Page 65 and 66: The Digestive SystemIntroduction an
Page 67 and 68: Where there is a range of values in
Page 69 and 70: Appendix 1GlossaryCauda equina synd
Page 71 and 72: WorkCover Tasmania - Template for R
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WorkCover Tasmania - Template for R
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