Compensation examination of the cervical and lumbar spines: critical disagreement in radiographic interpretation

Radiographic interpretation is often the major factor in the decision to award compensation for job-related complaints, especially in the Veterans Administration system. Three board-certified radiologists reviewed 200 consecutive lumbar and cervical spine examinations and assigned each case to one of three categories: normal, normal for age (not compensable), or degenerative disease (compensable). A critical disagreement, in which at least one radiologist considered the examination compensable and another not compensable, occurred in interpretation of 31% of the cervical and 46% of the lumbar spine examinations. Although the overall detection of radiographic findings was similar among all three radiologists, diagnostic interpretation of the findings varied greatly. Although most radiologists and orthopedists agree that the use of plain radiography of the spine as a deciding factor in awarding compensation is unjustified and inappropriate, until the regulations are changed there is a pressing need for strict, objective, radiographic criteria for determining "normal aging" of the cervical and lumbar spines so that interpreatations can be more uniform.