Table 15-3 Criteria for Rating Impairment Due to Lumbar Spine Injury: (Page 384)

DRE: LUMBOSACRAL SPINE:

DRE Lumbar Category III:
10% - 13% WPI

No significant clinical findings.
No observed muscle guarding or spasm.
No documented neurologic impairment.
No documented alteration in structural integrity of the spine.
No other indication of impairment related to the injury, illness, or fractures.

Clinical history and examination findings are compatible with a specific injury; findings may include significant muscle guarding or spasm observed at the time of the examination, asymmetric loss of range of motion, or nonverifiable radicular complaints - defined as radicular pain without objective findings, no alteration of the structural integrity of the spine, and no significant radiculopathy.

OR

Individual had a clinically significant radiculopathy and has an imaging study that demonstrates a herniated disc at the level and on the side that would be expected based on the previous radiculopathy, but no longer has the radiculopathy following conservative treatment.

OR

Fractures: (1) Less than 25% compression of one vertebral body; (2) posterior element fracture without dislocation (not developmental spondylolysis) that has healed without alteration of motion segment integrity; (3) a spinous or transverse process fracture with displacement but without a vertebral body fracture that does not disrupt the spinal canal.

Significant signs of radiculopathy, such as dermatomal pain and/or in a dermatomal distribution, sensory loss, loss of relevant reflex(es), loss of muscle strength, or measured unilateral atrophy above or below the knee compared to measurements on the contralateral side at the same location. Impairment may be verified by electrodiagnostic finds.

OR

History of a herniated disc at the level and on the side that would be expected from objective clinical findings, associated with radiculopathy, or individuals who had surgery for radiculopathy but are now asymptomatic.

OR

Fractures: (1) 25% to 50% compression of one vertebral body; (2) posterior element fracture with displacement disrupting the spinal canal; in both cases, the fracture has healed without alteration of structural integrity.

Meets the criteria of both DRE III and DRE IV, i.e., both radiculopathy and altered motion segment integrity are present; significant lower extremity impairment is present as indicated by atrophy or loss of reflex(es), pain, and/or sensory changes within an anatomic distribution (dermatomal), or electromyographic findings as stated in Category DRE III and alteration of spine motion segment integrity as defined in lumbosacral category DRE IV.

OR

Fractures: (1) greater than 50% compression of one vertebral body with unilateral neurologic compromise.

Table 15-4 Criteria for Rating Impairment Due to Thoracic Spine Injury: (Page 389)

DRE: THORACIC SPINE:

DRE Thoracic Category III:
15% - 18% WPI

No significant clinical findings.
No observed muscle guarding or spasm.
No documented neurologic impairment.
No documented changes in structural integrity of the spine.
No other indication of impairment related to the injury, illness, or fractures.

Clinical history and examination findings are compatible with a specific injury or illness; findings may include significant muscle guarding or spasm observed at the time of the examination, asymmetric loss of range of motion (dysmetrial), or nonverifiable radicular complaints - defined as radicular pain without objective findings, and no alteration of motion segment integrity.

OR

Herniated disc at the level and on the side that would be expected from objective clinical findings, but without radicular signs following conservative treatment.

OR

Fractures: (1) Less than 25% compression of one vertebral body; (2) posterior element fracture without dislocation that has healed without alteration of motion segment integrity or radiculopathy; (3) a spinous or transverse process fracture with displacement but without a vertebral body fracture.

Ongoing neurologic impairment of the lower extremity related to a thoracolumbar injury, documented by examination of motor and sensory functions, reflexes,or findings of unilateral atrophy above or blow the knee related to no other condition; impairment may be verified by electrodiagnostic testing.

OR

Clinically significant radiculopathy, verified by an imaging study that demonstrates a herniated disc at the level and on the side that would be expected from objective clinical findings; and/or history of radiculopathy, which has improved following surgical treatment.

OR

Fractures: (1) 25% to 50% compression of one vertebral body; (2) posterior element fracture with mild displacement disrupting the spinal canal; in both cases, the fracture has healed without alteration of structural integrity; differentiation from a congenital or developmental condition should be accomplished, if possible, by examining preinjury roentgenograms, if available, or by a bone scan performed after the onset of the condition.

Impairment of the lower extremity as defined in thoracolumbar category III and loss of structural integrity as defined in thoracic category IV.

OR

Fractures: (1) greater than 50% compression of one vertebral body with neural motor compromise but not bilateral involvement that would qualify the individual for corticospinal tract evaluation.

Table 15-5 Criteria for Rating Impairment Due to Cervical Spine Injury: (Page 392)

DRE: CERVICAL SPINE:

DRE Cervical Category III:
15% - 18% WPI

No significant clinical findings.
No observed muscle guarding or spasm.
No documented neurologic impairment.
No significant loss of motion segment integrity of the spine.
No other indication of impairment related to the injury, illness, or fractures.

Clinical history and examination findings are compatible with a specific injury or illness; findings may include muscle guarding or spasm at the time of the examination by a physician, asymmetric loss of range of motion, or nonverifiable radicular complaints - defined as complaints of radicular pain without objective findings, and no alteration of structural integrity.

OR

The individual had clinically significant radiculopathy and an imaging study that demonstrated a herniated disc at the level and on the side that would be expected based on the radiculopathy, but has improved following nonoperative treatment.

OR

Fractures: (1) Less than 25% compression of one vertebral body; (2) posterior element fracture without dislocation that has healed without loss of structural integrity or radiculopathy; (3) a spinous or transverse process fracture with displacement.

Significant signs of radiculopathy, such as pain and/or sensory loss in a dermatomal distribution, loss of relevant reflex(es), loss of muscle strength, or unilateral atrophy compared with the unaffected side, measured at the same distance above or below the elbow; the neurologic impairment may be verified by electrodiagnostic findings.

OR

Individual had clinically significant radiculopathy, verified by an imaging study that demonstrated a herniated disc at the level and on the side expected from objective clinical findings with radiculopathy or with improvement of radiculopathy following surgery.

OR

Fractures: (1) 25% to 50% compression of one vertebral body; (2) posterior element fracture with displacement disrupting the spinal canal; in both cases, the fracture is healed without loss of structural integrity; radiculopathy may or may not be present; differentiation from congenital and developmental conditions may be accomplished, if possible, by examining preinjury roentgenograms or a bone scan performed after the onset of the condition.

Significant upper extremity impairment requiring the use of upper extremity external functional or adaptive device(s); there may be total neurologic loss at a single level or severe, multilevel neurologic dysfunction.

OR

Fractures: structural compromise of the spinal canal is present with severe upper extremity motor and sensory deficits but without lower extremity involvement.