Case Vignette

Multi-level Lumbar Spinal Injuries


Lumbar spinal maladies are best assessed using Chapter 15 in the American Medical Association publication entitled “Guides to the Evaluation of Permanent Impairment” (5th Edition).  Other tomes can also be used should the jurisdiction dictate.

Multiple lumbar vertebrae fracture

Under normal circumstances, lumbar spinal maladies should be assessed using the Diagnosis Related Estimate Category system.  In the lumbar spine, there are five such categories with whole person impairments ranging from 0 to 28% depending upon the severity of the condition.

Thoracic fracuture with lumbar vertebral fracture dislocation

Is it Always the DRE Method?


In the instance where two or more sections of the lumbar spine have been injured in a subject accident, it is then mandated that the so-called “Range of Motion Method” is used to quantify the impairment.  Instead of using the DRE method, the expert will consult with Table 15-7 on page 404 of the AMA 5 Guides.  Allowances will be made for fractures, disc derangements, slippages of one vertebral body on another or compression of the spinal cord as in spinal stenosis.  It will also be necessary to measure limitations in range of motion of the lumbar spine in the forward, backward and sideways directions.    The true and final loss can then be quantified.


It is important that your expert has been trained in the proper use of all of the guides to the evaluation of permanent impairment used by all of the jurisdictions.  Inaccurate analyses can give rise to considerable difficulties with your negotiations in the future.