Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cauda Equina Syndrome


Related Terms

  • CES
  • Lumbosacral Nerve Root Compression
  • Neuromuscular Disorders

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)

Comorbid Conditions

  • Ankylosing spondylitis
  • Lesions of the spinal cord
  • Tumor

Factors Influencing Duration

Factors that may affect the length of disability include the underlying cause of the condition, extent of functional loss that persists after surgery, severity of pain, and other symptoms associated with the condition.

Medical Codes

ICD-9-CM:
225.3 - Benign Neoplasm of Brain and Other Parts of Nervous System; Spinal Cord; Cauda Equina
344.6 - Cauda Equina Syndrome
344.60 - Cauda Equina Syndrome without Mention of Neurogenic Bladder
344.61 - Cauda Equina Syndrome with Neurogenic Bladder
952.4 - Injury to Nerves and Spinal Cord, Cauda Equina

Overview

Cauda equina syndrome (CES) is a rare and serious disorder that is considered a medical emergency. It involves compression of the cauda equina, a bundle of spinal nerve roots that descends from the bottom end of the spinal cord and comprises all the spinal nerve roots below the level of the first lumbar vertebra (the sacral and coccygeal nerves). It is so named because it resembles the tail of a horse. This compression results in a dull pain in the lower back and buttocks, possible numbness, and disturbances in the bladder, rectum, and/or external genitalia.

Pressure on these nerves may result in the development of a lesion in the nervous system causing weakness in bladder control (neurogenic bladder) and loss of bowel control from a loose rectal sphincter. Sexual function may also be impaired; males may experience erectile dysfunction.

The many causes of CES include traumatic injuries, tumors, herniated lumbar discs, spinal stenosis, spinal neoplasm, inflammatory conditions such as Paget's disease and ankylosing spondylitis, infectious diseases, and iatrogenic causes.

Use of continuous spinal anesthesia during surgical procedures also increases the risk of developing cauda equina syndrome.

Incidence and Prevalence: The reported incidence of cauda equina syndrome resulting from herniated lumbar disc varies from 1% to 15% annually in the US (Hodges).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report loss of bladder and/or bowel control; abnormal touch sensations (paresthesias) in which the individual feels as though tiny insects are crawling over the skin (formication) or as though the skin is burning or prickling; and a loss of sexual function (erectile dysfunction). Pain or numbness in the back, rectal area, or both lower legs may also be reported. Leg symptoms may be reported on both sides, but one side may be more affected. Numbness in the perineum may also occur. If the condition is due to a tumor, there may be paralysis, leg muscle loss (atrophy), and inability to flex the foot upward (foot drop).

Physical exam: The exam may reveal precipitating conditions such as disc herniation, spondylitis, or arthritis. Localization of the pain to a specific area and alterations of motor, reflex, or sensory function in the legs provide clues to the diagnosis. Neurological examination may show muscle weakness and absence of deep tendon reflexes in the lower extremities, with accompanying numbness that extends to the genital and anal (perineum) area (areflexia paralysis). There may be a loss of anal sphincter tone (sphincteric disorder) noted on rectal examination.

Tests: Tests may include CT, MRI, or myelogram. Other x-rays or a bone scan may be obtained to diagnose the underlying cause. Measurement of the pressure exerted at varying degrees of capacity of the urinary bladder (cystometrogram) may reveal weakness of bladder control and disturbances of bladder function that produces urgency and incontinence.

Source: Medical Disability Advisor



Treatment

Surgery is the treatment of choice for this condition. In most cases, emergency decompression surgery relieves pressure on the nerves and prevents permanent nerve damage. The timing of surgical decompression is controversial, but most surgeons recommend emergent decompression, preferably within 48 hours after onset of cauda equina syndrome, over delayed surgery. Medication for pre- and postoperative pain may be necessary.

Source: Medical Disability Advisor



Prognosis

Outcome depends on prompt diagnosis and surgical treatment. Bladder and rectal dysfunction is associated with a delay in surgery. Significant improvement in sensory and motor deficits and urinary and rectal function occurs with emergent decompression within 48 hours. Preoperative conditions like back pain are associated with urinary and rectal dysfunction, and preoperative rectal dysfunction is associated with worsened outcome in urinary incontinence. In addition, increasing age is associated with poorer postoperative sexual function.

Source: Medical Disability Advisor



Rehabilitation

The team caring for an individual with a spinal cord injury may include a social worker, vocational specialist, and occupational therapist. Rehabilitation protocol depends on the severity of spinal cord injury, not the cauda equina syndrome itself. However, it is imperative that cauda equina syndrome be alleviated before a rehabilitative plan is set. If this syndrome goes unattended, severe and permanent damage to bladder and bowel may result, compounding the individual's recovery from the spinal injury.

Once decompression surgery is performed, the only therapy is rest until bladder and bowel dysfunction can be assessed.

During the initial stages of exercise, catheterization may be necessary to assist with bladder control. Bowel movements are assisted through gravity and exercise. Since the individual loses voluntary control of bowel function initially, accidents may occur during exercise sessions that require walking movements. As healing from the cauda equina injury occurs, normal or close to normal bladder and bowel function may resume. However, full recovery of bladder and bowel function may take up to 2 years.

Concomitant with neurogenic (originating from nerves) dysfunction of the bladder and bowel, muscle weakness or paralysis may occur in the lower extremities. These problems are addressed based on the extent and severity of injury.

An occupational therapist may assist with wheelchair and daily living skills training. If the individual returns to work, vocational rehabilitation may also be necessary. In some cases, the work environment must be adapted to accommodate not only the individual's physical disabilities but also the problems of bowel and bladder functioning. Therapeutic outcomes for individuals with spinal cord injury with cauda equina syndrome are variable and may include full or partial paralysis with bladder and bowel dysfunction.

Source: Medical Disability Advisor



Complications

Preoperative back pain and bladder or bowel dysfunction may require urgent surgery and complicate the surgical outcome.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations depend on the extent of damage to the nerves, degree of postoperative pain, and impairment of bladder and rectal functions. Persistent sensory and motor deficits may affect the individual's ability to perform work even in a limited capacity.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did patient have a recent traumatic injury?
  • Was diagnosis of cauda equina syndrome confirmed?
  • If cauda equina syndrome was suspected, was a radiographic examination required to confirm the diagnosis?
  • Was a CT, MRI, x-ray, or a bone scan obtained to diagnose the underlying cause?
  • Do difficulties with bladder control warrant further testing?

Regarding treatment:

  • Was individual adequately medicated for pre- and postoperative pain?
  • Was the surgery successful in decompressing the spinal nerve roots?

Regarding prognosis:

  • Do bladder and rectal dysfunction persist?
  • Were complications associated with the surgical procedure? If so, what were they, and what further treatment will they require?
  • What additional pain relief and/or functional recovery is still expected?

Source: Medical Disability Advisor



References

Cited

Hodges, Scott D., Jason C. Eck, and Craig Humphreys. "Cauda Equina Syndrome." eMedicine. Eds. James F. Kellam, et al. 7 Jul. 2004. Medscape. 21 Sep. 2004 <http://emedicine.com/orthoped/topic39.htm>.

Source: Medical Disability Advisor






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