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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

AMA Guides 5th Edition: Questions and Answers

In an effort to clarify some of the many errors in the 5th edition, The Guides Newsletter has added a question and answer section. The May/June 2001 Q&A section addressed several areas which are worth sharing with you as it clears up areas which have been difficult to interpret. The areas of potential misinterpretation are summarized below.

PROBLEM: Can motion segment integrity be assessed without dynamic studies?

ANSWER: NO. Loss of motion segment integrity can only be suspected by non-stress studies. This finding must be demonstrated on dynamic studies (flexion/extension or fluoroscopy).

PROBLEM: The guides are unclear regarding multi-level involvement and the use of the ROM vs DRE impairment methods. Must there be radiculopathy present when considering multilevel disc herniations for the ROM method?

ANSWER: YES. The Spine chapter authors require that radiculopathy be present when using the ROM method to rate multi-level disc herniations. They point out that multilevel disc herniations are commonly seen among asymptomatic individuals and may not be significant.

PROBLEM: The Spine chapter’s DRE method allows for a range of 3% based upon severity. The Pain chapter also allows for 3% increase for pain. Are these 3% increases independent of each other?

ANSWER: NO. The Pain and Spine chapters are written by different authors. This is a case of the left hand not knowing what the right hand is doing. The Spine chapter chairperson states that these are not separate considerations. Use of both of these methods would be duplicative and inappropriate.

COMMENT: If in fact this is the case, there are potentially large voids in impairment percentages using the DRE method. The DRE ranges are 5%-8%, 10%-13% 15%-18%, etc. There are potential gaps from between 2% and 7%. How is this “dead zone” explained?

PROBLEM: Do repeat spine traumas always require the use of the ROM method ?

ANSWER: NO. The authors state that, in the absence of radiculopathy, multiple traumatic events to the same region should remain in the DRE realm. However, they do comment that the higher end range may be used if appropriate.

COMMENTS: This is contrary to my original interpretation based on the criteria described on pages 379-380 and the related flow chart. The flow chart clearly shows that repeat injury follows a different impairment course. The authors clearly rely on radiculopathy as the prime determinant.

You can be sure that there will be many more areas which will need to be clarified. We will be sure to stay on top of these changes and clarifications and keep you up to date