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Spondylolisthesis versus Alteration of Motion Segment
Integrity
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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Greetings!
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!
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| Screening Impairment Rating Reports |
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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.
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Complimentary Video on AMA
Guides |
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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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Click here to gain access |
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Listen to Expert Teleconference Call on the
Guides |
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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. |
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Click here to listen to this very informative
discussion. |
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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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Guides IQ -
Only 1 week away |
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It is just one week away to the official launch of GuidesIQ
- the unique solution you have been looking for to master the
AMA Guides to the Evaluation of Permanent Impairment. On
demand, high quality, streaming Video presentations and
resources on the Guides - the most innovative resource ever
available – both for training and ongoing expert resource. We
want to share this information with as many individuals as
possible. Can you assist us in this process? Your colleagues
will greatly appreciate this resource.
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
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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.
- Target audience: Physicians, Adjusters, Attorneys,
Hearing Officers, Nurses, Judges
- Video and training presentations - always available -
efficient
- Taught by the leading medical expert on the Guides
- Low cost - high value
- Musculoskeletal and pain focus
- Continuing Medical Education – 16 hours
If you can’t wait the one week to the launch, Click
Here – you will have access to a free 40 minute video
presentation on assessing carpal tunnel syndrome impairment!
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