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.

Discectomy


Related Terms

  • Excision of Intervertebral Disc

Specialists

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

Comorbid Conditions

  • Alcohol abuse
  • Degenerative spine conditions (e.g., arthritis, ankylosing spondylitis)
  • Infection
  • Inflammatory disease
  • Malnutrition
  • Nerve root damage
  • Obesity
  • Poor physical conditioning
  • Tobacco abuse

Factors Influencing Duration

The individual’s general health, age, access to rehabilitation, extent of surgical procedure, number and location of discs involved, concurrent procedures performed such as laminectomy or spinal fusion, and whether surgery successfully treated an underlying disc disease all influence duration. Prior back surgery and the length of time individual had experienced radicular pain prior to discectomy can also influence recovery time.

Medical Codes

ICD-9-CM:
80.5 - Excision, Destruction, and Other Repair of Intervertebral Disc
80.50 - Excision or Destruction of Intervertebral Disc, Unspecified; Unspecified as to Excision or Destruction
80.51 - Excision of Intervertebral Disc; Discectomy; Level: Cervical, Thoracic, Lumbar (Lumbosacral); Removal of Herniated Nucleus Pulposus; That by Laminotomy or Hemilaminectomy; That with Decompression or Spinal Nerve Root at the Same Level
80.59 - Other Destruction of Intervertebral Disc; Destruction NEC; That by Laser

Overview

A discectomy is the surgical removal of herniated disc material from the spinal canal. The discs between the spinal vertebrae (intervertebral discs) consist of a gel-like center (nucleus pulposus) enclosed in a fibrous covering (annulus fibrous). A herniated disc occurs when the covering is damaged and the gel-like material is extruded. Discectomy is accomplished either by direct incision over the affected vertebra and underlying disc (open discectomy), through a small incision using a microscope and special equipment (microdiscectomy), or by laser (laser discectomy). The surgery includes removing fragments of the disc that has been herniated to relieve pressure on the affected nerve root. Discectomy can be performed to remove cervical discs from the neck region, thoracic discs from the mid-back, or lumbar discs from the lower back.

Individuals who have failed to respond to several months of conservative treatment for herniated disc may require surgical intervention. Onset of symptoms such as perineal numbness, loss of bowel or bladder control, and decreased sensation in or decreased motor control of the lower extremities requires emergency surgical treatment to relieve pressure on (decompress) the spinal cord and nerve roots and to prevent permanent paralysis and permanent loss of bowel or bladder control.

Source: Medical Disability Advisor



Reason for Procedure

A discectomy is performed for two reasons. The first and most common reason is to decrease unrelenting arm (cervical spine) or leg (lumbar spine) pain or progressive neurological deficits caused by pressure on a spinal nerve root from a herniated disc. The usual indication is nerve root (radicular) pain present for at least 2 to 3 months. The second indication for discectomy is as an emergency treatment for spinal cord compression of the cervical or thoracic spine or compression of nerves at or below the lumbar spine (cauda equina syndrome). At the first lumbar vertebra, the spinal cord branches into a bundle of nerve roots that innervate the legs, bowel, and bladder. Cauda equina syndrome is caused by compression of these nerve roots. A number of conditions can affect this portion of the spinal cord, including disc herniation, injury, infection, tumor, spinal stenosis, and inflammation. Left untreated, cauda equina syndrome can result in permanent paralysis of the legs and loss of bowel and/or bladder control.

Source: Medical Disability Advisor



How Procedure is Performed

Removal of herniated disc material can be accomplished by an open technique using an incision along the spine. Open discectomy is performed under general anesthesia. The space where the nerve root exits the spinal canal also may need to be enlarged to relieve pressure on the nerve root (foraminotomy). The initial step is to remove a portion of the vertebra that forms the roof over the spinal nerves (laminectomy). This creates a small window that allows the surgeon to view the interior of the spinal canal and perform the surgery. Surgical instruments are then used to remove the herniated disc material, thus relieving the pressure on the nerve root. Most of this disc material is from the nucleus pulposus.

Microdiscectomy, also called minimally invasive spine surgery, is an alternative to open surgery for certain types of disc herniation, usually of the lumbar spine. In microdiscectomy, a special operating microscope is used to view the disc and spinal nerves through a small (2 to 4 cm) incision in the back. Smaller and lighter surgical instruments are used to remove herniated disc material through the small incision with minimal trauma to surrounding tissue. Many individuals who undergo microdiscectomy are discharged after overnight observation and have relief of symptoms with minimal soreness.

In video-assisted discectomy, a flexible fiberoptic instrument with a tiny camera attached is inserted through a small incision to allow visualization of the involved disc. Surgical instruments are then inserted through other small incision(s) to remove the protruding disc material as video images guide the surgeon. The camera and instruments may be inserted into the spine through the back (posterior approach) or through the chest cavity (video-assisted thoracic surgery VATS). The primary goal of these micro-procedures is to remove the portion of the disc that is causing compression of the nerve root while minimizing trauma to local tissue and decreasing scar tissue formation.

Laser discectomy is a newer technique that is performed as an outpatient. It differs from the previous methods in that herniated disc material is not removed but is vaporized. Laser discectomy is performed under local anesthesia with light sedation. After preparation of the individual, a needle is inserted into the disc and a portion of the nucleus pulposus is burned away, decreasing volume of the disc and thus relieving the pressure within it. This method is minimally invasive, cost-effective, and relatively pain free. As of 2008, laser discectomy was best suited to a subset of individuals who meet strict criteria (e.g., leg pain from radiculopathy who have no progressive neurological deficits, no stenosis or facet hypertrophy, and no history of prior surgery at that disc level). Further studies are needed to show that laser discectomy a safe and effective treatment that is superior to traditional methods.

Other new techniques under development include several methods to decompress the disc centrally (chemical, enzymatic, vaporization, or mechanical), directed fragmentectomy, and anterior cervical interbody fusion.

Source: Medical Disability Advisor



Prognosis

Relief of pain and increased movement and function are usually obtained from discectomy, and individuals often are able to resume work and daily activities soon after surgery. Good to excellent results with laser discectomy have been reported in multiple studies, with success rates ranging from 78.4% to 85% (Chawla); success was defined as minimal discomfort and the ability to return to work. Another study of the effectiveness of microdiscectomy reported rapid initial recovery in patients with sciatica due to disc herniation and a history of pain for less than 12 weeks; other individuals had modest benefit during a 2-year follow-up, and conservative therapy was believed to be sufficient for a good outcome (Osterman). A good outcome is usually defined as a reported decrease in pain, reduced use of pain medications, and a prompt return to work. Emergency surgery for cauda equina syndrome can improve symptoms, but there may be some residual leg weakness or loss of bladder and/or bowel control.

Treatment failures are more commonly related to post-traumatic or work-related injuries. There is no cure-all for back pain and individuals who expect to be completely pain-free after discectomy may be gravely disappointed.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation for discectomy will vary significantly based on the location of the disc and the surgical procedure used. The primary focus of rehabilitation following discectomy is to promote independence in all functional activities.

Early ambulation should be encouraged, and assistive devices may be used as needed. Proper transfer techniques should be taught to maximize independence and minimize discomfort. These techniques may include log rolling for bed mobility and use of the upper extremities to assist with transfers. Gentle isometric exercises of the trunk stabilizing muscles may be initiated unless contraindicated.

When indicated by the treating physician, usually around 4 to 6 weeks postoperatively, patients may be progressed to a more aggressive exercise program (Danielsen, Ostelo). Rehabilitation should emphasize stretching, strengthening, stabilization and aerobic exercises as well as instruction of proper body mechanics. Stretching, strengthening and stabilization exercises should focus on the muscles around the trunk, hips, and thighs. Improved general aerobic conditioning has been shown to yield better postoperative outcome (Dolan). Low impact activities, such as walking and swimming, may be beneficial after discectomy to improve general fitness.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistDiscectomy
Physical TherapistInpatient: daily
Physical TherapistOutpatient (lumbar spine): up to 6 visits within 6 weeks
Physical TherapistOutpatient (cervical spine): up to 12 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

As with most surgical procedures, complications with discectomy can include bleeding, infection, adverse reaction to anesthesia, and formation of blood clots. Other rare complications include nerve damage, spinal fluid leakage, an increase in pain, and a decrease in sensation and motor control of the lower extremities.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

As in all conditions affecting the spine, overhead work, repetitive bending, unassisted carrying and lifting, and prolonged sitting should be restricted or eliminated during the initial phase of recovery from surgery. Individuals with multiple back or neck surgeries are usually given permanent restrictions forbidding work that involves heavy or very heavy lifting. Individuals may need to get up frequently from a seated position (as often as every 20 minutes) and walk to relieve discomfort and to help prevent scar tissue formation.

Source: Medical Disability Advisor



References

Cited

Danielson, J. M., et al. "Early Aggressive Exercise for Postoperative Rehabilitation after Discectomy." Spine 25 8 (2000): 1015-1020. National Center for Biotechnology Information. National Library of Medicine. 15 Nov. 2004 <PMID: 10767815>.

Dolan, P., et al. "Can Exercise Therapy Improve the Outcome of Microdiscectomy?" Spine 25 12 (2000): 1523-1532. National Center for Biotechnology Information. National Library of Medicine. 15 Nov. 2004 <PMID: 10851101>.

Ostelo, R. W., et al. "Rehabilitation Following First-Time Lumbar Disc Surgery: A Systematic Review Within the Framework of the Cochrane Collaboration." Spine 28 3 (2003): 209-218. National Center for Biotechnology Information. National Library of Medicine. 15 Nov. 2004 <PMID: 12567020>.

Osterman, H., et al. "Effectiveness of Microdiscectomy for Lumbar Disc Herniation: A Randomized Controlled Trial with 2 Years of Follow-up." Spine 31 21 (2006): 2409-2414. National Center for Biotechnology Information. National Library of Medicine. 17 Dec. 2008 <PMID: 17023847>.

General

Chawla, Jasvinder. "Laser Discectomy." eMedicine. Eds. Francisco Talavera, et al. 7 Jun. 2006. Medscape. 17 Dec. 2008 <emedicine.com/neuro/topic683.htm>.

Source: Medical Disability Advisor






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