AMA Guides Information and Resources
August 31, 2006

in this issue

Spondylolisthesis versus Alteration of Motion Segment Integrity

Screening Impairment Rating Reports

Complimentary Video on AMA Guides

Listen to Expert Teleconference Call on the Guides

On the Calendar

Guides IQ - Only 1 week away


 

Spondylolisthesis versus Alteration of Motion Segment Integrity
Guides Newsletter

by Craig M. Uejo MD, MPH

This is the fifth in a series of articles written to assist evaluators in their use and interpretation of The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition (Cocchiarella L, Andersson G, AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, AMA Press, 2001). It will be used to help summarize key points of clarification documented in past issues of The Guides Newsletter. References to specific issues will be provided to allow anyone the opportunity to review the entire issue/article for assistance in understanding and accuracy of reporting.

This particular article will discuss the issues of whether Spondylolisthesis noted on static view radiographs is evidence to support an impairment rating for Alteration of Motion Segment Integrity (AMSI). This particular issue was discussed in the the July/August 2003 edition of The Guides Newsletter.

Spondylolisthesis versus Alteration of Motion Segment Integrity (AMSI)

Spondylolisthesis is not equivalent to alteration of motion segment integrity. While spondylolisthesis may represent a condition in which there was a level of instability present in the lumbar spine, the AMA Guides, 5th ed. does not equate the two terms. The finding of spondylolisthesis is not considered an impairment by itself without significant “instability” radiographically documented at MMI.

This issue was explored in the July – August 2003 issue of the Guides Newsletter. As noted in that issue, the finding of spondylolisthesis, in itself, does not result in ratable impairment. Alteration of motion segment integrity exists only when there is significant dynamic increased translational or angular motion, eg, demonstrated by flexion vs extension views and meeting the definitions provided in the Guides, or a successful or unsuccessful surgical fusion. Some of the confusion concerning the term used in the Guides re alteration of motion segment integrity arises because multiple different, but similar, terms exist.

In any case, spondylolisthesis without flexion/extension views that document evidence of instability at MMI is not ratable as AMSI.

Look for additional articles in this series, The Guides Newsletter – Important Clinical Concepts from Past Issues, coming in upcoming issues of this Brigham and Associates Ezine.




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Hope you are all having a great summer! Please find information on new approaches and information on the AMA Guides. We love to hear your feedback!


Screening Impairment Rating Reports
AMA Guides

DID YOU KNOW that most impairment evaluations are performed incorrectly? The American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment are complex. Therefore, it may not be possible to recognize errors. Incorrect ratings are costly; you cannot afford to accept a rating unless you can verify it is accurate. We highly recommend the review of all impairment rating reports. Our clients are reporting a several fold return on this very effective case intervention.

We are pleased to introduce a very cost effective screening method of determining if an impairment evaluation was correct or not. This compliments our widely acclaimed review services and is applicable to anyone who wants to determine if a rating is reliable; our clients include claims professionals, attorneys (defense and plaintiff), and physicians. This screening report presents our conclusions in this case, however does not include the narrative discussion and explanations provided in our standard Rating Review reports. (For cases where the report is to be used for feedback to the original rating physician, evidence in the case, to prepare for cross- examination, or negotiations we recommend our standard reports.) The fee for an “Impairment Screen” is $95 if the original rating was correct and $195 if it was incorrect. This low-cost option is most useful for screening purposes and internal case management. After your review of the Rating Screen we can provide a detailed narrative report at an additional charge.

Response time from when records are provided to your receipt of the report is usually 5 working days or less. Reports required in less than 5 working days are available at additional fee; at the time of the referral specify the date required – we will do everything possible to provide you with a report on or before that date.

  • Complimentary Video on AMA Guides
  • 101 DVD

    Free immediate access to the Video Presentation – “Impairment Rating in California Workers' Compensation: AMA Guides 101”. As a thank you for providing us with the email addresses of two of your colleagues, we will provide you with two weeks of free access to the Video Presentation "Impairment Rating in California Workers' Compensation: AMA Guides 101" (retail value of the DVD is $395.) We will email your two referrals once, explaining to them our resources, also offering access to the AMA Guides 101 video, and providing them with the option of subscribing to our highly acclaimed (and complimentary) ezine.

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  • Listen to Expert Teleconference Call on the Guides
  • Listen in on a recording of the August 24, 2006 teleconference call of the Brigham and Associates, Inc. expert reviewer team as we explore challenges in rating impairment using the AMA Guides to the Evaluation of Permanent Impairment. Our special guest is Charles Brooks, MD, a world class orthopedic surgeon from Seattle, Washington. In this one hour call we explore issues in rating spine and extremity disorders.

    Click here to listen to this very informative discussion.
  • On the Calendar
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    Dr. Brigham is a featured speaker at:

    California Association of Joint Powers Authority, South Lake Tahoe, CA, September 20-22, 2006: Misuse and Abuse of the AMA Guides

    Please visit us at our Exhibit at these conferences:

    CSIA Oktoberfest of Learning, October 6, 2006, San Francisco, CA

    California Workers' Comp Forum, October 18-20, 2006, Huntington Beach, CA

    National Workers' Comp & Disability Conference, Las Vegas, NV, November 14-16, 2006

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    In terms of GuidesIQ you will learn more about this next week, and we will provide you with a special introductory offer. In the past, to learn how to use the Guides you would need to travel to seminars, giving up endless hours of your very precious time - and then weeks later you encounter a rating issue and do not clearly recall what to do. Or you would need to struggle on your own to interpret the Guides - often incorrectly - since content may not be clearly defined. Imagine the benefits of gaining access to over 60 educational modules on the AMA Guides and the knowledge, skill and expertise to be gained from the world’s leading expert on the Guides. These numerous modules were designed for the specific learning needs of physicians, attorneys, claims professionals and fact finders (judges and hearing officers). After participating in GuidesIQ you will dramatically increase your ability to perform, review and manage impairment ratings. You can return to these presentations again and again during the coming year to revisit topics based on specific case needs. This resource is essential for your success and that of your organization.

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