Disability Evaluation in Spinal Fracture

Hak-Jin Min

doi:10.4184/jkss.2006.13.4.348

Journal List > J Korean Soc Spine Surg > v.13(4) > 1035743

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Min: Disability Evaluation in Spinal Fracture

Original Article

Journal of Korean Spine Surg 2006;13(4):348-355.

Published online: 21 February 2006

DOI: https://doi.org/10.4184/jkss.2006.13.4.348

Disability Evaluation in Spinal Fracture

Hak-Jin Min, M.D.

Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea

Address reprint requests to Hak Jin Min, M.D. Department of Orthopaedic Surgery, Seoul Medical Center Sam sung-dong, kangnam-ku, Seoul 171-1, Korea Tel: 82-2-3430-0621, Fax: 82-2-539-1262, E-mail: spinemin@dreamwiz.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

REFERENCES

1). Cocchiarella L, Andersson GBJ. Guides to the Evaluation of Permanent Impairment. 5th ed.AMA Press;2000.

2). Korean Orthopaedic Association. 장해 판정 기준 -정형외과학 분야-. 1st ed.Seoul Medical Book Company;2005.

3). Lee KS. 배상과 보상의 의학적 판단 -신경계 장애 중심-. 4th ed.Joongang Cultural Book Company;2001.

4). Lim KS. 새로운 신체장해평가법. 3rd ed.Joongang Cultural Book Company;1999.

5). McBride ED. Disability Evaluation and Principles of Treatment of Compensable Injuries. 6th ed.Philadelphia: Lippincott Co.;1963.

Table 1.

Disability rate due to Spinal Column Injury by McBride's Method

		Vertebral Body	Lamina	Spinous or Transverse Process
	75% normal	17~40 (27)	12~37 (23)	11~31 (18)
Cervical	50% normal	26~49 (36)	19~42 (29)	16~39 (26)
	25% normal	47~70 (57)	33~56 (43)	24~47 (35)
	75% normal	17~40 (27)	08~27 (14)	12~37 (23)
Thoracic	50% normal	26~49 (36)	16~39 (26)	17~40 (27)
	25% normal	45~68 (55)	32~55 (42)	24~47 (36)
	75% normal	20~45 (32)	16~39 (26)	16~39 (26)
Thoraco-Lumbar	50% normal	35~57 (45)	23~46 (34)	21~44 (31)
	25% normal	63~86 (73)	43~67 (53)	30~53 (41)
	75% normal	19~42 (29)	17~40 (27)	14~37 (24)
Lumbar	50% normal	35~57 (45)	24~47 (35)	19~42 (29)
	25% normal	63~86 (73)	40~63 (50)	30~53 (40)

Table 2.

Disability rate due to spinal cord injury by McBride's Method Ataxia, Locomotor, Paraplegic

A	Slight, periodic attack	10~26
B	Moderate, constant	30~46
C	Severe in all movement	70~84
D	Extreme; uncertainty in all movement, paraplegia of leg	100

Table 3.

Criteria for Rating Impairment due to spine injury by DRE method

I	no fracture
II	<25% compression of vertebral body
	post. element fx without dislocation, spinous or transverse process fx with displacement
III	25~50% compression
	post. element fx with displacement disrupting spinal canal
IV	>50% compression without residual neurologic compromise
V	>50% compression with unilateral neurologic compromise

Table 4.

Impairment Rate due to Spinal Column Injury by DRE method (Diagnosis-based evaluation)

	Cervical	Thoracic	Lumbar
I	0	0	0
II	5~8	5~8	5~8
III	15~18	15~18	10~13
IV	25~28	20~23	20~23
V	35~38	25~28	25~28

Table 5.

Impairment Rate due to Spinal Column Injury by ROM method

		Cervical	Thoracic	Lumbar
A	Compression of one vertebral body
	0~25%	04	2	5
	26~50%	06	3	7
	>50%	10	5	12
B	Fracture of post. Element (pedicle, lamina, articular process, transverse process)	04	2	5
C	Reduced dislocation of one vertebra	05	3	6

Table 6.

Impairment Rate due to Operated Spinal Column Injury by DRE method

		Cervical	Thoracic	Lumbar
A	Single-level decompression without spinal fusion and without residual signs or symptoms	07	4	08
B	Single-level decompression without spinal fusion with residual signs or symptoms	09	5	10
C	Single-level spinal fusion with or without decompression without residual signs or symptoms	08	4	09
D	Single-level spinal fusion with or without decompression with residual signs or symptom	10	5	12
E	Multiple levels, operated on, with residual, medically documented pain and rigidity		Add 1% per level
	1. Second operation		Add 2%
	2. Third or subsequent operation		Add 1% per operation

Table 7.

Criteria for Rating Spinal cord impairment

1	1 upper extremity impairment	1~60%
2	2 upper extremity impairment	1~80%
3	Station and Gait impairment	1~60%
4	Bladder impairment	1~60%
5	Anorectal impairment	1~50%
6	Sexual impairment	1~20%
7	Respiration impairment	5~90%

The impairment is estimated according to the effects on the ability to perform activities of daily living and results of neurologic examination and testing

Table 8.

Disability Rate due to Spinal Column Injury without Neurologic Injury (KOA*)

A. Operated Fracture
1. Cervical, Thoracic	25
2. Thoracolumbar (T10-L1), Lumbar	30
B. Non-Operated Fracture remaining pain and limitation of motion
1. Compression of Vertebral Body <25%
a. Cervical, Thoracic	08
b. Thoracolumbar, Lumbar	10
2. Compression of Vertebral Body 25-50%
a. Cervical, Thoracic	10
b. Thoracolumbar, Lumbar	15
3. Compression of Vertebral Body >50%
a. Cervical, Thoracic	15
b. Thoracolumbar, Lumbar	20

* :Korean Orthopaedic Association

Table 9.

Fracture of Spinous Process or Transverse Process

A	Residual Pain and Limitation of Motion	8
B	Non-Union	8
C	Multiple Fractures 3 or more	10

Table 10.

Disability Rate due to Spinal Fracture and Dislocation (KNSS*)

	Cervical	Thoracic	Lumbar
A. Compression of Vertebral Body
a. 0~25%	1~8	01~80	1~8
b. 26~49%	09~18	09~18	09~18
c. >50%	19~28	19~23	19~28
B. Fracture except Vertebral Body
a. Disrupting spinal canal (-)	01~80	01~80	1~8
b. Disrupting spinal canal (+)	09~18	09~13	09~18
C. Reduced Dislocation	07~13	07~10	07~10

Add 3% per Level in Multiple Fracture Accompanying Root Injury 5~15* : Korean Neurosurgery Society

Table 11.

Disability Rate in Case Remaining Instability, Deformity or Performing Spinal Fusion

	Cervical	Thoracic	Lumbar
A. Evident Spinal Instability	10~13	15~28	15~28
B. Performing Spinal Fusion
a. 1 or 2 Level
1. Without Neurologic Deficit	10~23	10~23	15~28
2. With Neurologic Deficit	20~33	20~33	25~38
b. 3 Level or more
1. Without Neurologic Deficit	15~28	15~28	20~33
2. With Neurologic Deficit	25~40	25~40	30~45
C. Deformity
a. Scoliosis 25~39		20~29
b. Scoliosis >40		30~40
c. Kyphosis 30~59		20~29
d. Kyphosis >60도		30~40

Table 12.

Comparison of Various Evaluation Method in Vertebral Body Fracture

Vertebral Body Fracture		McBride I-A	AMA		KOA*	KNSS**
Vertebral Body Fracture		McBride I-A	DRE	ROM	KOA*	KNSS**
Cervical	00~25%	17~40	5~8	04	08	1~8
	25~50%		15~18	06	10	09~18
	>50%		25~28	10	15	19~28
Thoracic	00~25%	17~40	5~8	02	08	1~8
	25~50%		15~18	03	10	09~18
	>50%		20~23	05	15	19~23
Thoraco-Lumbar	00~25%	22~45			10
	25~50%				15
	>50%				20
Lumbar	00~25%	19~42	5~8	05	10	1~8
	25~50%		10~13	07	15	09~18
	>50%		20~23	12	20	19~28

* :Korean Orthopaedic Association ** :Korean Neurosurgery Society

Table 13.

Comparison of Various Evaluation Method in Vertebral Body Fracture Performing Operation

Fracture Performing Operation	McBride I-A	AMA (ROM*)		KOA**	KNSS***
Cervical	None	1 Level RS# (-)	1 Level RS (+)	25	1-2 Level	3 or more Level
Cervical	None	8	10	25	10~23	15~28
Thoracic	None	4	05	25	10~23	15~28
Thoracolumbar	None	Add 1% per Level	Combine with LOM##	30
Lumbar	None	9	12	30	15~28	20~33

* :Range of Motion ** :Korean Orthopaedic Association *** :Korean Neurosurgery Society # :Residual Symptom and Sign ## :Limitation of Motion

Table 14.

Comparison of Various Evaluation Method in Other Part of Vertebral Fracture except Vertebral Body

Other Part Fracture	McBride I-A		AMA		KOA*	KNSS**
Cervical	lamina	Process	DRE	ROM	Pain or LOM 8	Disrupt canal (-)	Disrupt canal (+)	Reduced Dislocation
Cervical	12~37	11~31	5~8	4	Pain or LOM 8	1~8	9~18	7~13
Thoracic	08~27	12~37	5~8	2	Non-union 8	1~8	9~13	7~10
Thoraco-Lumbar	16~39	16~39			Non-union 8
Lumbar	17~40	14~37	5~8	5	Multiple (3 or more)10	)1~8	9~18	7~10

* :Korean Orthopaedic Association ** :Korean Neurosurgery Society

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