AMA Guides® Newsletter - Issue Archive

Articles

1. Rating Spinal Nerve Extremity Impairment Using the Sixth Edition (Authoritative Article*)

   Christopher R. Brigham

   Pages 1–6

   DOI: 10.1001/amaguidesnewsletters.2009.JulAug01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.
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2. Degenerative Disc Disease: The Myth of Work-Related “Cumulative Trauma”

   Christopher R. Brigham, James B. Talmage, Charles Brooks, Gunnar Andersson, Craig Uejo

   Pages 7–12

   DOI: 10.1001/amaguidesnewsletters.2009.JulAug02

   Abstract

   The primary cause of degenerative disc disease (DDD) is nonoccupational factors such as genetics and aging, and attributing DDD to “cumulative trauma” at work is a myth that is not supported by current scientific evidence. Some authors have suggested that DDD is a misnomer because the condition is not a disease but rather an inevitable component of the aging process that occurs at variable rates in different persons. Causation analysis requires a link between a cause and an effect, and reference to “cumulative trauma” without identification of a specific accident is incomplete. Physicians appear sometimes to opine “to a reasonable degree of medical certainty” that certain work events caused or aggravated a condition solely on the basis of a temporal relationship. Further, DDD usually is not the cause of neck or back pain but rather is an incidental finding on x-rays or advanced imaging studies. A dominant view of disc degeneration has been that disc structures are damaged by occasional excessive forces and the cumulative effects of repeated loading—but modern science contradicts this view. The authors examine current publications regarding DDD (including four full abstracts from recent articles) and conclude that current scientific evidence does not support the premise that “cumulative trauma” results in or aggravates degenerative disc disease. “Repetitive strain injury” of the spine is a mythical medicolegal concept, not a clinical or pathologic reality.
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