Evaluating Lumbar Radiculopathy

Abstract

For workers’ compensation, most requests for a permanent impairment rating of low back injuries involve the diagnostic labels of nonspecific chronic low back pain or intervertebral disk herniation. Use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to choose the right diagnosis and class for these injuries is the first step and involves correctly choosing between “nonverifiable radicular complaints” and “residual radiculopathy.” Evaluators must be able to distinguish persisting radiculopathy, as defined in the sixth edition, from resolved radiculopathy and from nonverifiable radicular complaints and to support findings with objective clinical evidence. Clinical evidence of chronic radiculopathy might include motor weakness, muscle atrophy, impaired sharp–dull discrimination, and/or abnormal electrodiagnostic tests, provided the findings are persistent and there are reflex abnormalities. When considering radiculopathy in the appropriate spine grid of the AMA Guides, Sixth Edition, the evaluator must distinguish radicular (limb) symptoms that are continuous, intermittent, or completely resolved. Positive electromyography (EMG) studies for acute radiculopathy are a sufficient objective finding to state the person has radiculopathy on the date of the test; individuals with positive needle EMG do have persisting radiculopathy at maximum medical improvement, but this does not mean that radiculopathy must persist despite time and treatment.