Low Back Pain: A Common Sense Approach #2

Saturday, February 26, 2005 | 0

This is the second and concluding article on the evaluation of soft tissue injuries and low back pain in particular. It deals with a new technique in the evaluation of these costly and omnipresent complaints.

For many years medical practitioners of all types were devoid of a complete tool to assist their many years of training and experience in the soft tissue injury evaluation process. The issues at hand were the verification and age of an injury. These factors are critical to assigning financial responsibility and designing an appropriate treatment for what has become a $200 billion dollar problem growing at double digit rates. Commonly used tools such as CT and MR lack the ability to opine on causality, work relatedness and apportionment as related to "age" of the injury. They often find pathology unrelated to the medical complaint at hand. SB 899 recognized the importance of these issues and attempts to address this need by focusing the discussion in these areas. Functional Capacity examinations lack in the same areas and are further complicated by the lack of objectivity and reliability, is based on loading, archaic methodologies and offers nothing in assisting the medical part of a claim. Needle EMGs are invasive and open to inter-reader variability and artifact.

Additionally, these poor diagnostic tools have not been able to adequately distinguish acute from chronic injury, which in turn produced more failures. All these failed procedures often placed the medical community against the legal profession producing expensive delays.

One innovative, ACOEM compliant solution, CMAP(tm), created the new field of Dynamic Neuromyography and was developed by Medical Technologies Unlimited whose local office is in Novato California.

This unique patent pending design has received FDA 510k Class 2 approval and consists of five (5) generally performed medical evaluations (functional capacity, range of motion, pinch, grip, and electromyography) under the domain of a computer driven protocol designed for the problem at hand (low back, for example) with simultaneous recording via a novel web-cam based mechanism.

After a careful and complete history the patient is tested through a series of non-loading, non-invasive steps, based on the AMA fifth edition guide, designed to evaluate the body area (low back, cervical, extremities, etc) in question using all the five modalities above. This data, which is not alterable once accepted, is transmitted digitally to a server which scans for patterns indicative of typical and atypical disease states specific to that body part being tested. All abnormal patterns are sent to the medical team of forensic specialists for final review and quality assurance before the final report is generated and sent to the treating physician in their own digital mailbox. An impairment rating, if requested, may also be provided in compliance with the AMA guides. A digital copy is created for off-site storage and an electronic invoice is generated. This entire process has a "bench speed" of 3 minutes, limited only by the speed of the uploading sites (testing facility) internet connection.

The process which manages the work flow is a proprietary design fully interactive with a doctors electronic medical records and can interface with systems for other diagnostic services such as MR and CT, as well as practice management software. This allows the user to manage inventory of supplies, scrub for data correlation such as injury type, pattern, recurrence issues, claim frequency and other custom needs.

The powers of the technology are just now being harnessed. The patient receives a quick and reliable diagnosis and the physician has an objective, scientific tool to fortify diagnostic impressions and guide management decisions supported by legally admissible data which has never been excluded in court. Determining compliance is an enhancement over classic FCEs and is accomplished by documenting muscle firing upon testing. The ability of this test to differentiate acute from chronic injury by diverse signal patterns offers information and impressions related to compensability previously only postulated. The ability to assess the clinical significance of disc pathology (is there evidence of muscle dysfunction in the appropriate neural distribution) overrides the MRI in this regard, as 70% of all MR studies show an "abnormality," many of which are not symptomatic, especially in the low back. Post offer/pre-placement, ergonomic evaluations, comparative success analysis of pain management and rehabilitation programs, IME and peer review functions are also being utilized.

A recent seminar in Palm Springs by the American Academy of Pain Medicine and subsequent publication(s) reported a landmark study documenting the reproducibility and reliability of scientific, evidenced based testing for spine related complaints as described in this article. A second study of EMG signal intensity documented correlation with symptom severity in chronic back problems. A meta-analysis of 45 similar studies further documents the benefits mentioned in this summary article.

In summary, it seems the future will not be "business as usual" for the evaluation of both acute and chronic back complaints. It will be important for all involved to evolve with new solutions for an old problem.

Marco N. Vitiello, M.D., is Chairman and CEO of MED-TEK in Miami, FL. He can be reached at (305) 595-7177, or by e-mail at mvitiello@med-tek.com>.

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