The mystery of SIGMD for spinal impairment assessment revealed

 

Mr Thomas Kossmann presented a breakfast seminar on the new SIGMD legislation and in case you missed it, Lex Medicus is released a few articles to provide you with a comprehensive description of this new method of spine assessment.

There are rumours about the newly SIGMD guidelines wanted by the TAC but many are still unsure what it exactly means, how it is conducted and as to what extent it differs from previous methodology.

In these articles, our Director Thomas Kossmann explains the features of SIGMD, including its implications for Victorian TAC insured clients.

The SIGMD was published in the Victoria Government Gazette on 6 October 2016 (Special Gazette, No. S 305).

All amendments are intended to apply from the date of Royal Assent of the Amendment Act (13 December 2016). Meanwhile, a number of health professionals of different specialities have been trained in the application of SIGMD.

The Amendment Compensation Legislation Amendment Act 2016 (No. 73/2016) (the Amendment Act) made the following changes to the Transport Accident Act 1986. Importantly, the SIGMD legislation is only for use in some TAC claims in TAC Jurisdiction. It does not apply to Worksafe Vic or Wrongs Act and it is actually unlawful to use it for other claims. It can be used only for claims where the date of accident is 14.12.2016 or later.

Therefore, people who suffered spinal injuries in transport accidents on or after 14 December 2016 must undergo the impairment assessment according to the SIGMD. As always with new guidelines, the day-to-day application of SIGMD will demonstrate whether this methodology covers all aspects of spine pathologies, which may be found in patients with traumatic spine injuries caused by transport accident.

This is the first of a series of articles distributed by Lex Medicus. In this first article, Thomas Kossmann illustrates the application with two cases utilising a direct comparison using SIGMD and the previous assessment methodology. In future, we will publish more information and examples of impairment assessment of the spine and some important limitations of the SIGMD.

 

The anatomy of the spine seen from the front, back and side. The sacrum is no longer part of the spine according to SIGMD.

 

There are some major changes that SIGMD entails when compared to the impairment assessment according to the 4th edition of the AMA Guides to the Evaluation of Permanent Impairment. For more details, we advise to read the Victoria Government Gazette No. S 305. Table A gives an overview of the different categories, which apply to the impairment assessment according to SIGMD.

Major changes:

1.    SIGMD differentiates if there are conditions affecting
a.    Single vertebra       >  Column 1
b.    Multiple vertebrae   > Column 2
c.    Surgical procedure  > Column 3

2.    The occipital condyle is included in the cervicothoracic (cervical) region, which includes the C1-C7 vertebrae and motion segments C0-C1 to C7-T1 inclusively.

3.    The thoracolumbar region includes the T1 to T12 vertebrae and the motion segments T1-T2 to T 11-T12.

4.    The lumbosacral region includes the L1 to L5 vertebrae and the motion segments Th12-L1 to L5-S1.

5.    The sacrum is not assessed under the SIGMD spine but as part of the impairment of the pelvis.

6.    Certain spinal procedures to the cervical, thoracic and lumbar spine are assessed according to SIGMD as DRE category I (0% Whole Person Impairment). They include: injection, vertebroplasty performed by needle, a percutaneous spinal procedure other than discectomy, laminectomy or laminotomy, implantation of a spinal cord stimulator and /or drug delivery system as well as similar minor spinal procedures.

7.    An impairment can only be awarded if the relevant descriptor is strictly satisfied. Please see the descriptors in the respective columns. A typical example is mentioned in 6.3.6, page 5, of the Victoria Government Gazette No. S 305.

 

Case No 1:

Left: Illustration showing the fracture on the transverse process of the lumbar vertebra from the back and Right: the transverse process seen from the top

A 57-year-old pedestrian crosses the street with the traffic light on green and is hit by a car and thrown to the ground. He complains of pain in his lower back and is transported by ambulance to the hospital. At clinical examination, the patient presents a bruise around the lumbar spine. The x-rays show an isolated fracture of the right transverse process of the lumbar vertebra L3. The patient has no radiculopathy and no other injuries. After an observation period, he is discharged from the hospital and referred to the care of his GP.

 

1. Medico-legal impairment assessment if the spine injury occurred on 13.12.2016

The isolated transverse process fracture is evaluated using Table 70, page 3-108 of 4th edition of the AMA Guides to the evaluation of permanent impairment:

DRE Lumbosacral Category II: 5% Whole Person Impairment.

2. Medico-legal impairment assessment if the spine injury occurred on or after 14.12.2016

The isolated transverse process fracture is evaluated using Table R 72 page 12, SIGMD, Victoria Government Gazette No. S 305.

DRE Lumbosacral Spine Impairment I: 0% Whole Person Impairment.

 

Case No 2:

Left:  X-ray of the lumbar spine showing the fracture of three transverse processes to the right side. Right: spine view from the side.

 

A 23-year-old woman is riding her motorbike correctly when a car in front of her performs a U-turn leading to a collision. The patient is thrown over the bonnet and falls on her back. She does not lose consciousness but feels excruciating pain in her lumbar spine, yet maintaining movement of the lower extremities. Subsequently, the patient is transported to the hospital and haematuria (blood in urine) is diagnosed. Following x-rays to the chest, pelvis and lumbar spine as well as CT scans of her chest and abdomen she is diagnosed with multiple right-sided transverse process fractures of the lumbar spine, but no injuries to the kidneys or other abdominal organs. The haematuria settles and she can be mobilised with pain killers. After three days of observation, she is discharged from the hospital.

 

1. Medico-legal impairment assessment if the spine injury occurred on 13.12.2016

The multiple transverse process fractures are evaluated using Table 70, page 3-108 of 4th edition of the AMA Guides to the evaluation of permanent impairment:

DRE Lumbosacral Category IV: 20% Whole Person Impairment.

2. Medico-legal impairment assessment if the spine injury occurred on or after 14.12.2016

The isolated transverse process fracture is evaluated using Table R 72 page 12, SIGMD, Victoria Government Gazette No. S 305.

DRE Lumbosacral Spine Impairment II: 5% Whole Person Impairment.

 

These cases clearly demonstrate the significant difference in the percentage of Whole Person Impairment between the two methods of spinal assessment.