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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.

Fracture, Cervical Spine (With Spinal Cord Injury)


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
806.00 - Closed Fracture of C1-C4 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.01 - Closed Fracture of C1-C4 Level of Vertebral Column with Complete Lesion of Cord
806.02 - Closed Fracture of C1-C4 Level of Vertebral Column with Anterior Cord Syndrome
806.03 - Closed Fracture of C1-C4 Level of Vertebral Column with Central Cord Syndrome
806.04 - Closed Fracture of C1-C4 Level of Vertebral Column with Other Specified Spinal Cord Injury
806.05 - Closed Fracture of C1-C4 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.06 - Closed Fracture of C5-C7 Level of Vertebral Column with Complete Lesion of Cord
806.07 - Closed Fracture of C5-C7 Level of Vertebral Column with Anterior Cord Syndrome
806.08 - Closed Fracture of C5-C7 Level of Vertebral Column with Central Cord Syndrome
806.09 - Closed Fracture of C5-C7 Level of Vertebral Column with Other Specified Spinal Cord Injury
806.10 - Open Fracture of C1-C4 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.11 - Open Fracture of C1-C4 Level of Vertebral Column with Complete Lesion of Cord
806.12 - Open Fracture of C1-C4 Level of Vertebral Column with Anterior Cord Syndrome
806.13 - Open Fracture of C1-C4 Level of Vertebral Column with Central Cord Syndrome
806.14 - Open Fracture of C1-C4 Level of Vertebral Column with Other Specified Spinal Cord Injury
806.15 - Open Fracture of C1-C4 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.16 - Open Fracture of C5-C7 Level of Vertebral Column with Complete Lesion of Cord
806.17 - Open Fracture of C5-C7 Level of Vertebral Column with Anterior Cord Syndrome
806.18 - Open Fracture of C5-C7 Level of Vertebral Column with Central Cord Syndrome
806.19 - Open Fracture of C5-C7 Level of Vertebral Column with Other Specified Spinal Cord Injury

Related Terms

  • Broken Neck
  • Upper Spine Fracture

Overview

Fracture of the cervical spine is a break in one or more of the seven connected bones (vertebrae) in the neck (cervical) region. Cervical spine and spinal cord injuries are primarily the result of traumatic injuries to the head and neck. The most frequent injuries result from vehicle collisions, diving into shallow water, and gunshot wounds to the neck. Neurological injury occurs in 40% of individuals with fracture at the cervical level. The farther the fracture is up the spine, the more function the individual is likely to lose. When the spinal cord has been injured, the difference between an individual losing function in the legs (becoming a paraplegic) and losing function in both arms and legs (becoming quadriplegic) depends on which vertebra (or vertebrae) was fractured. Quadriplegia (tetraplegia) results when spinal cord injury occurs in the cervical region. An individual with an unstable fracture is at risk for spinal cord injury unless the fracture is stabilized.

Incidence and Prevalence: About 6,000 to 10,000 people in the US suffer spinal cord injuries each year; about 55% to 75% of these injuries are caused by auto accidents and falls; the remainder result from collisions or falls during sports and other recreational activities (Khosla).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The average age at injury is 38.0 years. Rates among persons older than 60 mark a significant increase in this group, reaching 11.5%. Males account for 77.8% of spinal cord injuries. As of 2000 the ethnic distribution of spinal cord injuries is as follows: 63% are Caucasian, 22.7% are black, and 11.8% are Hispanic. Motor vehicles are involved in 46.9% of spinal cord injury, followed by falls and acts of violence ("Spinal Cord Injury…").

Source: Medical Disability Advisor



Diagnosis

History: Fracture or dislocation of the cervical spine is suspected in any individual who complains of neck pain or numbness or tingling in the extremities following an injury. These symptoms usually begin in the hours after an accident, but it can sometimes take months for the injury to become apparent. A carefully taken history is recorded regarding the nature of the accident. An individual may report being thrown from a vehicle and striking is or her head. Immediately after the accident, the individual may already show signs of paralysis. Individuals who lose function in all four limbs (quadriplegia) may initially move hands or feet briefly following the injury. This is important for the diagnosis and prognosis of neurological injury. There may also be a history or previous episodes of cervical spine disease, such as injuries, paralysis, weakness, spondylosis, or seizures.

Physical exam: A neurosurgeon or orthopedic spine surgeon must examine the individual frequently in the days after the injury. A neurologist may be consulted to help determine which limbs and other parts of the body are unresponsive to stimuli and whether function is likely to return.

Tests: X-rays, CT, and complex-motion tomographic studies (TOMOS) determine the site and extent of the fracture. MRI is also usually obtained.

Source: Medical Disability Advisor



Treatment

Because 50% of the neurologic deficits seen with spinal cord injury occur in the hours after the actual injury (Khosla) and the extent of damage to the spinal cord is not fully determined at the time of initial hospitalization, individuals with broken necks and neurologic deficit are generally administered massive doses of steroids as soon as possible after injury (within 4 hours) to facilitate neurological recovery, although there is controversy as to whether this is actually helpful. Management of acute cervical spine injuries with neurologic deficit consists of bed-based skeletal traction until all non-neurological injuries are evaluated. Early application of a whole-body apparatus to restrict movement (halo body vest) provides immediate cervical stabilization and facilitates the diagnostic workup and treatment of individuals with multiple injuries.

It is imperative to realign the bony fragments in the cervical spine and reduce the joint dislocation as quickly as possible. This can be done using skeletal traction, a halo body vest, and / or operative internal stabilization for unstable fractures. Pain relievers (analgesics) may be given.

Source: Medical Disability Advisor



Prognosis

The prognosis for individuals with cervical spine fracture ranges from never being able to use any limbs again (quadriplegia) to recovering completely after the fracture heals, depending on whether there is a spinal cord injury. The outcome for an individual with lost limb function depends greatly on the cause of the cervical spine fracture and spinal cord injury.

Partial spinal cord injuries usually demonstrate some degree of neurologic improvement over time, unlike injuries with immediate, complete, and persistent loss of function below the level of injury.

Neurologic injury from cervical spine fracture may decrease life expectancy, with more severe paralysis and higher-level fracture predicting the greatest decreases in life expectancy. This decrease in life expectancy is mainly due to recurrent pneumonia, recurrent urinary tract infection, and the individual's inability to maintain cardiac and muscle fitness.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

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

Source: Medical Disability Advisor



Rehabilitation

A cervical spine fracture with spinal cord injury may deeply affect every aspect of the individual's life. Therefore, rehabilitation must address each of these components, including the individual's functional status in all environments (home, work, and community) (Kirshblum).

Rehabilitation guidelines will be based on the fracture type, the level and extent of spinal cord involvement, and the type of fracture management (operative, nonoperative) (Bucholz). The stability of the fracture must be ascertained prior to proceeding with rehabilitation.

With spinal cord involvement, a comprehensive multidisciplinary rehabilitation program is indicated to optimize functional abilities (Kirshblum). Some areas that require special attention following a spinal cord injury include motor status (muscle tone), sensory status (proprioception), autonomic functions (bowel and bladder management), and psychosocial and occupational status (Kirshblum).

Motor rehabilitation includes range of motion of all limbs and the trunk to prevent contractures and to control muscle spasticity (Kirshblum). Strengthening of all remaining active muscles is indicated to maximize functional abilities. Sensory rehabilitation focuses on exercises that emphasize motor control and spatial awareness through movement. Independence in bowel and bladder control is the goal when possible, and retraining the muscles that control these functions is another component of rehabilitation (Kirshblum). As a result of the life changes imposed by such a condition, the individual may benefit from the support of a psychologist/psychiatrist. Despite severe disability, reemployment is possible, and a vocational counselor may be needed to assist the individual (Kirshblum). In some individuals, breathing status may be compromised and must be managed by a respiratory therapist. When possible, to prevent pulmonary complications, such as atelectasis and pneumonia, breathing exercises must be emphasized during rehabilitation. Sexual dysfunction commonly results from a cervical spinal cord injury and should be addressed by an appropriate healthcare professional (Kirshblum).

An important component of the rehabilitation process is identifying equipment needs and modifying the individual's environment to accommodate special needs; the goal of all rehabilitation is to promote independence as much as possible and to minimize the residual disability (Kirshblum).

Additional information may provide greater insight into the rehabilitation needs of these individuals (Kendall; McKinley; Sumida; Tooth). For a more detailed description of the rehabilitation, see Spinal Cord Injury.

FREQUENCY OF REHABILITATION VISITS
ClassificationSpecialistTopicVisit
Nonsurgical and SurgicalPhysical TherapistFracture, Cervical Spine (With Spinal Cord Injury)Up to daily for 26 weeks
Nonsurgical and SurgicalOccupational TherapistFracture, Cervical Spine (With Spinal Cord Injury)Up to daily for 26 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



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications include infection after open fractures or open reduction, nerve damage in displaced fractures or fracture dislocations, and bone healing with faulty alignment (malunion). If the spinal cord is damaged, additional complications from paraplegia or quadriplegia include pneumonia, recurring urinary infections, decubitus ulcers, nephrolithiasis, and osteoporosis.

Source: Medical Disability Advisor



Factors Influencing Duration

The most important factors that determine long-term functional results after injuries to the cervical spine include the level of trauma to the vertebrae, whether the individual sustained additional trauma to the rest of the body, the position of the affected vertebrae, whether the fracture is stable or unstable, the individual's health (excellent or poor) at the time of trauma, and, most important, the severity of the initial neurological deficit. The nature of an individual's work, the individual's age, complications from the injury, and stability of the fracture will also influence the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Spinal cord injury, even with partial neurologic recovery, usually precludes moderate and heavy work, so disability may be permanent for heavy work. Individuals will need time off for visits to physicians and therapists. They may take medications for pain and so should not operate heavy machinery or fly airplanes until neurologic recovery is complete and the fracture heals. Fractures that heal with significant deformity may be incompatible with heavy or very heavy work.

For a quadriplegic individual to return to work, the individual must have enough upper limb function to do the job, with or without assistive devices. Many "quadriplegic" individuals have some use of their upper limbs. Motorized wheelchairs and voice-activated computers permit individuals with some degrees of quadriplegia to perform some work functions. The workplace must be wheel chair accessible (ramps and elevators instead of stairs). Larger employers are required to make the workplace accessible to the handicapped by the Americans with Disabilities Act. Individuals need time off for follow-up visits to physicians and therapists.

The US Social Security Administration's criteria for permanent and total disability due to spinal cord injury are "significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements or station and gait." Thus even those with just paraparesis (bilateral leg weakness, but not complete paralysis) who require use of a wheel chair meet the Social Security Administrations definition of (criteria for awarding) disability compensation.

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:

  • What was mechanism of injury?
  • At what level in neck did injury occur?
  • Does individual have stable fracture? An unstable fracture? How was the fracture treated? Is the fracture healed? If "yes," is it healed in good position or in poor position?
  • Is part time or full time use of a ventilator (respirator) required?
  • What level of neurologic function in the arms and legs is still present?
  • Does individual have history of seizures or cognitive impairment from an associated brain injury?
  • Are there associated chest, abdominal, or extremity injuries delaying recovery?

Regarding treatment:

  • Did the individual receive treatment in a hospital and rehab unit dedicated to spinal cord injury patients? If "no," has outpatient consultation with a spinal cord injury center clinic system occurred?
  • Would placement is a group living residence for those with spinal cord injury facilitate return to work?

Regarding prognosis:

  • Has a physical therapist shown the individual how to do range of motion exercises? Has individual incorporated them into the home exercise program?
  • Has an occupational therapist shown the individual how to maximize ability to do activities of daily living?
  • Is individual on ventilator?
  • Is respiratory therapist involved in care?
  • Is occupational therapist working with physical therapist to maximize individual's recovery?
  • Is speech therapist needed, and if "yes," is one on the treatment team?
  • Is there a psychologist or psychiatrist on treatment team? (Depression is a common reaction to devastating injury.)
  • Does individual have conditions that may affect ability to recover?
  • Has individual had complications, such as infection, nerve damage, malunion, kidney stones, or pneumonia?
  • Does individual have necessary adaptive equipment?

Source: Medical Disability Advisor



References

Cited

"Spinal Cord Injury: Facts and Figures at a Glance." SpinalCord Injury Information Network. Jun. 2006. University of Alabama at Birmingham. 12 Jan. 2008 <http://www.spinalcord.uab.edu/show.asp?durki=21446>.

Bucholz, Robert, and James D. Heckman. Rockwood and Green's Fractures in Adults. 6th ed. Philadelphia: Lippincott, Williams & Wilkins, 2005.

Kendall, M. B., G. Ungerer, and P. Dorsett. "Bridging the Gap: Transitional Rehabilitation Services for People with Spinal Cord Injury." Disability Rehabilitation 25 17 (2003): 1008-1015. National Center for Biotechnology Information. National Library of Medicine. 22 Nov. 2004 <PMID: 12851090>.

Khosla, Rocky. "An Occult Cervical Spine Fracture." Physician and Sportsmedicine 25 12 (1997): 69-73. The Physician and Sportsmedicine Online. McGraw-Hill Companies. 14 Jul. 2005 <http://www.physsportsmed.com/issues/1997/12dec/khosla.htm>.

Kirschblum, S., and Denise I. Campagnolo, eds. Spinal Cord Injury Medicine. Philadelphia: Lippincott, Williams & Wilkins, 2001.

McKinley, W. O., et al. "Nontraumatic vs. Traumatic Spinal Cord Injury: A Rehabilitation Outcome Comparison." American Journal of Physical Medicine and Rehabilitation 80 9 (2001): 693-699.

Sumida, M., et al. "Early Rehabilitation Effect for Traumatic Spinal Cord Injury." Archives of Physical and Medical Rehabilitation 82 3 (2001): 391-395.

Tooth, L., K. McKenna, and T. Geraghty. "Rehabilitation outcomes in Traumatic Spinal Cord Injury in Australia: Functional Status, Length of Stay and Discharge Setting." Spinal Cord 41 4 (2003): 220-230.

Source: Medical Disability Advisor