AMA Guides® Newsletter - Issue Archive

Articles

1. Lumbosacral Corticospinal and Cauda Equina Injuries

   Christopher R. Brigham

   Pages 1–9

   DOI: 10.1001/amaguidesnewsletters.2003.NovDec01

   Abstract

   Spinal cord injuries can affect many functions, interfere with the activities of daily living, and result in significant impairment. This article reviews cauda equina and conus medullaris syndromes, examines the process of rating corticospinal tract damage, and provides a case example. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), cauda equina syndrome refers to the polyradicular symptomatology resulting from single- or double-level compression of the lumbosacral nerve roots in the dural sac and may include low-back pain, saddle anesthesia, sciatica, motor weakness of the lower extremities, chronic paraplegia, and bladder, bowel, or sexual dysfunction. Conus medullaris syndrome is caused by a compression injury at T12 or L1, and flaccid paralysis of the legs and anal sphincter with variable sensory deficits may be present. The AMA Guides, Fifth Edition, includes Table 15-6, Rating Corticospinal Tract Impairment, which presents criteria for rating the neurological impairment. The physician must determine which systems are impaired, then which categories are appropriate and what value within a range should be selected. This requires the use of judgment because large ranges are provided. Spinal injuries that involve corticospinal tract damage are assessed using the Diagnosis-related estimate (DRE) method, but the range-of-motion method can be used in specified situations. A case example demonstrates how to assess neurological impairment.
   Show more

2. Legal Update: Use of the AMA Guides: 2003 Update

   Cathy V. Brigham, Christopher R. Brigham

   Pages 4–6

   DOI: 10.1001/amaguidesnewsletters.2003.NovDec02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is widely used in federal workers’ compensation, Longshore and Harbor Workers’ Act, and automobile casualty (personal injury) cases. The AMA Guides, Fifth Edition, is widely used, but not all state workers’ compensation systems make use of the current edition; in fact, relevant state statutes may or may not specify which edition of the AMA Guides to use and how to do so. Thirty-six states make use of the AMA Guides within their workers’ compensation systems, and 23 states use the Fifth Edition. Eleven states use the AMA Guides, Fourth Edition: Alabama, Arkansas, Connecticut, Delaware, Indiana (both Fourth and Fifth Editions), Kansas, Maine, Maryland, South Dakota, Texas, and West Virginia. Two states use the Third Edition, Revised: Colorado and Oregon. Some states do not use the AMA Guides and instead rely on state specific guidelines, and these include California, Florida, Illinois, Minnesota, New York, North Carolina, Utah, and Wisconsin. Other states may use their own guidelines for specific issues and use the AMA Guides for other issues (eg, state of Washington). Some states do not specify the use of any specific guidelines, including Michigan, Mississippi, Missouri, Nebraska, New Jersey, South Carolina, and Virginia. A table summarizes state statutes dealing with rating impairment in workers’ compensation cases, including AMA Guides edition most used, statute/code, comments, and relevant websites.
   Show more

3. Questions & Answers

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.2003.NovDec03