Recurrent lumbar radiculopathy (RLR) occurs between 5-15 % of cases.
AMA 4 does NOT specially address the situation of rating a back injury by the 'injury model' after there has been surgery. This is a MAJOR DEFICIENCY in the use of AMA 4 by insurers with a high incidence of RLR due to various factors.The philosophy of AMA4 is that radiculapathy is not quantifiable and, once it is present , it is permanent! Thus, there is no increase in the rating when recurrent radiculopathy occurs.While this may not seem fair, the philosophy of AMA 4 is that radiculopathy can be assigned to a person once only. THIS IS NOT A WELL KNOWN FACT AMONG INEXPERIENCED PI ASSESSORS.
AMA 5 includes revisions for rating PI of the spine that will in many cases be different compared with AMA 4. AMA 5 includes criteria for rating recurrent radiculopathy.The ROM Method is used (AMA 5 pp 380-381) and apportioning instructions are to subtract the prior injury rating (by using the old injury model of AMA 4) from the current rating (by using the ROM Method).
In summary : (i)AMA 4: verify presence of a radiculopathy including loss of reflexes, unilateral atrophy,and differentiators , including electrodiagnostic evidence. determine if any ratable impairment is present, including loss of motion segment integrity. Impairment is then based on the INJURY MODEL.
(ii) AMA 5: Determine the appropriate method for assessment, then apply the specific method to suit the case specifics.
ASSISTANT PROFESSOR MICHAEL CORONEOS CIME MASE
SENIOR NEUROSURGEON & PI ASSESSOR
CIME & MASE
NATIONAL RACS EXAMINER & SENIOR RACS MORTALITY ASSESSOR (QASM).
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