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.

Curvature of the Spine, Acquired


Related Terms

  • Abnormal Spine Curvature
  • Idiopathic Scoliosis
  • Kyphoscoliosis
  • Kyphosis
  • Lordoscoliosis
  • Lordosis
  • Scoliosis

Specialists

  • Cardiovascular Internist
  • Chiropractor
  • Neurologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Pulmonologist
  • Radiologist

Comorbid Conditions

  • Cardiopulmonary conditions
  • General debility
  • Obesity

Factors Influencing Duration

Factors include type and severity of the spinal curvature, development of complications, type of treatment, individual's response to treatment, and individual's job or lifestyle requirements.

Medical Codes

ICD-9-CM:
737.10 - Kyphosis, Acquired, Postural
737.20 - Lordosis, Acquired, Postural
737.30 - Scoliosis [and Kyphoscoliosis], Idiopathic
737.8 - Curvatures of Spine Associated with Other Conditions, Other Curvatures of Spine
737.9 - Curvature of Spine Associated with Other Conditions, Unspecified Curvature of Spine; Curvature of Spine (Acquired) (Idiopathic) NOS; Hunchback, Acquired

Overview

© Reed Group
When viewed from the side, the spinal column has a natural curvature. The cervical spine has a C-shape, or a normal lordotic curve; the thoracic spine has a reverse C-shape; and the lumbar spine has a normal lordotic curve. Abnormal increase or decrease in the curve may result from a pathologic condition, including developmental conditions or fractures. An increase in the normal lordotic curve of the cervical or lumbar spine is called hyperlordosis.

Scoliosis is a side-to-side deviation in the normally straight vertical line of the spine when viewed from behind. It may or may not include rotation or deformity of the individual vertebrae. Although some abnormal curvatures may be present at birth (congenital), most cases develop between adolescence and mid- to older adulthood and are described as “acquired” or “idiopathic.”

Scoliosis is the most common type of acquired abnormal spine curvature. It may be combined with kyphosis (kyphoscoliosis) or increased lordosis (lordoscoliosis). Scoliosis also may be described as fixed or compensated. Fixed scoliosis is a change in the structure of the vertebrae that results in a C-shaped or S-shaped spine that is not mobile. Compensated scoliosis has a flexible segment above or below the major curve and tends to maintain normal body alignment.

Idiopathic scoliosis is classified according to age of onset (infantile, juvenile, adolescent, or adult). Adolescent idiopathic scoliosis is the most common type, so-called because it is diagnosed in adolescence, even though it may have developed during childhood. Idiopathic scoliosis tends to run in families, suggesting a genetic predisposition for spinal curvature. Research is ongoing on the genetic roots of the disease. However, since evidence strongly suggests that scoliosis has a genetic component, it is advisable for a child who has a parent, brother, or sister with idiopathic scoliosis to undergo regular examination for scoliosis.

Researchers have suggested that a possible cause of idiopathic scoliosis is a primary muscle disorder associated with increased levels of contractile proteins of platelets (platelet calmodulin) in the blood; in individuals with adolescent idiopathic scoliosis, higher levels of platelet calmodulin were found in those with the most severe progression (Mehlman). Other possible explanations for the etiology of idiopathic scoliosis are a defect in connective tissue, melatonin deficiency, central nervous system lesions, and disorganized skeletal growth, but none of these has shown a direct cause/effect relationship.

In adults, scoliosis may represent progression of a spinal curvature that went undiagnosed during childhood or adolescence, or it can be caused by degeneration of the discs (intervertebral discs) that lie between the bones of the spine. Acquired scoliosis is described as idiopathic when no known cause has been identified. It may be termed adult-onset scoliosis when it is due to age-related degenerative disc disease.

Neuromuscular scoliosis involves muscular weakness, muscular imbalance, or neurologic dysfunction and paralysis, sometimes resulting from diseases such as muscular dystrophy, spina bifida, syringomyelia, Friedreich's ataxia, poliomyelitis, and cerebral palsy.

Acquired kyphosis is usually caused by trauma with an associated spine fracture but is also caused by osteoporosis, inflammation, disc degeneration, endocrine diseases, Paget's disease, poliomyelitis, tuberculosis, infection, and cancer of the spine. Scheuermann's kyphosis or disease is an abnormal increase in kyphosis of the thoracic spine resulting from structural changes to the vertebra. The cause is unknown, but the deformity is localized and painless.

Abnormal curvatures may be associated with other diseases such as neurofibromatosis, Marfan's syndrome, and Ehlers-Danlos syndrome. Regardless of the etiology, abnormal curvature may progress as the individual ages or as a result of a progressive condition.

Incidence and Prevalence: Approximately 2% of women and less than 0.5% of men have some amount of abnormal spine curvature. It can occur at any age, but is most often diagnosed during adolescence; 1.2% of individuals between 12 and 14 years of age had scoliosis (Mehlman).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who have a family history of abnormal spinal curvature and those who have an underlying disease that can affect muscles or bones of the spine (see above) are at an increased risk of developing abnormal curvature of the spine. Females are shown to be at greater risk than males for some types of scoliosis.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report perceived deformity or excessive curvature of the spine and related asymmetry of other parts of the torso (hips, shoulders, chest, and waistline). Leg length discrepancy related to an oblique pelvis may be noted by the individual or family members. Older individuals with possible degenerative scoliosis may complain of back pain and fatigue. Individuals with severe curvatures may complain of breathing difficulties and weakness. There may be a family history of abnormal spine curvature.

Physical exam: Examination will evaluate posture and body shape. Individuals with scoliosis may present with uneven (asymmetrical) hips and/or shoulders and an abnormal waistline tilt with pronounced indentation on one side of the back. Some findings may suggest a neuromuscular cause for the curvature: the skin overlying the spine may have light brown (cafe au lait) spots, hairy patches, dimples, or skin tags. Armpit (axillary) freckles may be seen. The individual may have an abnormal walking style (gait) and asymmetrical limb lengths. Clubbing of the fingers may indicate cardiopulmonary impairment seen only with severe deformity. Signs of kyphosis or kyphoscoliosis may include a rounded upper back, whereas individuals with abnormal lordosis will display a sway back. Posture is often noticeably poor because the individual attempts to compensate for improper alignment and muscle tension related to the curvature. The evaluating physician may perform a neurologic examination of the upper and lower extremities. Reflexes may be abnormal.

Spinal curvature may be apparent by the Adam's test, in which the individual bends forward with the legs straight and the arms extended, and the spine is examined for abnormal curves in that position. A rib hump or elevation of the scapula on one side is consistent with adolescent idiopathic scoliosis.

Tests: Plain x-rays of the spine may be taken with the individual standing, bending, and lying down. The curves are measured (Cobb angle measurement) and evaluated with respect to flexibility. MRI or myelogram with CT may be used in individuals with possible neurological abnormalities, unusual curve patterns, or rapidly progressive curvatures. Cardiac and pulmonary function tests are used for individuals with curvature greater than 60° or with signs and symptoms consistent with respiratory problems.

In patients scheduled for surgery, preoperative imaging, including CT myelogram or MRI, is usually performed to evaluate for potential spinal cord conditions. X-rays of the spine with measurement of the Cobb angle are used to evaluate kyphosis. Routine laboratory studies are performed preoperatively and will include hemoglobin and hematocrit; type and crossmatch may be done to reserve blood for possible transfusion during surgery.

Source: Medical Disability Advisor



Treatment

Most individuals with idiopathic scoliosis have no more spinal complaints than those without scoliosis. The presence of scoliosis does not necessarily mean the scoliosis is the source of spinal pain. If so, treatment will depend upon the extent and severity of the curvature, the age of the individual, and the underlying cause of the curvature. Several types of treatment are available. Mild curvatures (those less than 10°) in adults are usually treated to control symptoms. Conservative treatment may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain relief.

Kyphosis and lordosis are usually treated nonsurgically, unless significant deformity has developed.

More severe forms of spinal curvature require either immobilization (bracing) or surgery. Bracing may be appropriate initially in young individuals with mild to moderate curves when progression is expected. Surgery is indicated for individuals with progressive curvatures, curves greater than 40°, neuromuscular scoliosis, severe pain, and other significant symptoms (cardiac or pulmonary problems). The type of surgery is dependent on the type, severity, and extent of the curvature, the age of the individual, and whether previous attempts at corrections have been made.

Degenerative scoliosis is often compromised by spinal instability and spinal and foraminal stenosis, and surgical procedures to manage it may be more complicated.

A common surgical method used to realign the spine is spinal fusion (arthrodesis) with fixation devices (e.g., rods, screws), which may be performed either from the back (posterior approach) or through the chest (anterior approach) or both, depending on the shape and magnitude of the curve. Excision of intervertebral discs (discectomy) and/or removal of vertebral body or bodies (corpectomy) are surgical options used to improve flexibility and alignment of the spine prior to fusion. Surgery requires hospitalization, but individuals are mobilized early and may be discharged within 5 days postoperatively. Bracing may be recommended postoperatively for several weeks or months.

Source: Medical Disability Advisor



Prognosis

The greatest diagnostic challenge related to curvature of the spine is determining the possibility of progressive deformity. Progressive curvature in idiopathic scoliosis is predicted by considering the extent of deformity and indicators of skeletal maturity. Small curves and greater skeletal maturity have a lower risk of progression (2%) compared to large curves in less mature individuals for whom risk of progression is much greater (70%) (Mehlman).

For milder cases, conservative measures are effective in reducing pain and, possibly, deformity in young adults and adults with minor curvature. In most cases, reconstructive procedures have a good outcome and can reduce pain and deformity. Individuals with a degenerative disease or whole body (systemic) disease have a poor prognosis.

The prognosis following surgical treatment of scoliosis is strongly related to the original extent of the curvature deformity (curve magnitude) and the age and underlying medical status of the individual.

Source: Medical Disability Advisor



Rehabilitation

The primary focus of rehabilitation for acquired curvature of the spine is to relieve symptoms if present and to promote full function. Prior to initiating treatment, the therapist must consider the underlying etiology (Benoist). The individual may present with or without pain, and it is not always clear if the pain is related to the spinal curve. By determining if there is a relation between the underlying etiology and the individual's pain, the therapist can modify the treatment accordingly.

The initial goal of physical therapy is to reduce pain using thermal modalities. Individuals should be instructed in a stretching and strengthening exercise program of the spine and limbs. Exercises should emphasize an upright posture, and focused stretching and strengthening. All individuals, unless contraindicated, should begin a general aerobic exercise program. If the curvature of the spine has compromised the chest cavity, then breathing exercises should be taught to promote full lung expansion. If indicated, the curvature of the spine should be monitored for changes.

Education about caring for the back and the benefits of continued exercise is an important component of rehabilitation. A home exercise program should be taught to complement the supervised rehabilitation and to be continued independently after discharge from therapy. It may be beneficial for these individuals to have an ergonomic assessment, and subsequent modifications, if the individual finds work tasks difficult due to the spinal curvature.

Additional information may provide better insight into the rehabilitation needs of this population (Danielsson).

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistCurvature of the Spine, Acquired
Physical TherapistUp to 8 visits within 4 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Complications include progressive curvature, postural and neuromuscular problems, pain, difficulty walking, pronounced deformity, loss of height, and heart and lung problems.

Complications are rarely seen with contemporary surgical methods for scoliosis but may include fracture dislocations of vertebrae after spinal fusion, spinal cord injury, pseudoarthrosis, failure of instrumentation, pneumothorax, coagulation problems (coagulopathy), delayed infection, and chronic low back pain.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may need a leave of absence for surgery, recuperation, and physical therapy. Work restrictions and special accommodations need to be established on an individual basis. Activities involving lifting and carrying may need to be limited. Work station modification to permit good posture may be helpful. Individual may need to move and stretch regularly during work hours to avoid back pain and muscle fatigue. To reduce the risk of complications, individuals who are treated surgically may not be allowed to work during the early recovery period.

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:

  • Is individual's abnormal spine curvature congenital or acquired?
  • Is there a family history of scoliosis?
  • When was individual first diagnosed?
  • What kind of scoliosis does individual have? What is the degree of curvature, and has it progressed?
  • Does individual complain of back pain and fatigue? Breathing difficulties and weakness?
  • Was curvature apparent on physical exam?
  • Were plain x-rays performed? MRI or myelogram with CT?
  • Does individual have any risk factors?
  • Does individual show signs of neurologic involvement?
  • Is any underlying disease present that may be associated with curvature?

Regarding treatment:

  • Has individual responded favorably to conservative treatment?
  • Was surgery necessary?

Regarding prognosis:

  • Was surgery performed? What was the outcome? Did complications occur?
  • Is individual active in physical therapy? Is a home exercise program in place?
  • Can individual's employer accommodate necessary restrictions?
  • Is individual obese?
  • Does individual have a pre-existing cardiopulmonary condition?
  • Have any complications developed such as progressive curvature, postural and neuromuscular problems, pain, difficulty walking, pronounced deformity, loss of height, and heart and lung problems?

Source: Medical Disability Advisor



References

Cited

Benoist, M. "Natural History of the Aging Spine." European Spine Journal 12 Suppl 2 (2003): S86-S89. National Center for Biotechnology Information. National Library of Medicine. 22 Nov. 2004 <PMID 12961079>.

Danielsson, A. J., A. L. Nachemson, and . "Radiologic Findings and Curve Progression 22 Years After Treatment for Adolescent Idiopathic Scoliosis: Comparison of Brace and Surgical Treatment with Matching Control Group of Straight Individuals." Spine 26 5 (2001): 516-525. National Center for Biotechnology Information. National Library of Medicine. 22 Nov. 2004 <PMID 11242379>.

Mehlman, Charles T. "Idiopathic Scoliosis." eMedicine. Eds. Daniel Riew, et al. 1 Jul. 2008. Medscape. 2 Mar. 2009 <http://emedicine.medscape.com/article/1265794-overview>.

Source: Medical Disability Advisor






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