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 (Without Spinal Cord Injury)


Related Terms

  • Burst Fracture
  • Compression Fracture
  • Hangman's Fracture
  • Jefferson Fracture
  • Teardrop Fracture
  • Vertebral Fracture

Differential Diagnosis

Specialists

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

Factors Influencing Duration

The most important factor that determines the individual’s long-term functional abilities after injury to the cervical spine is how the injury was managed initially. Other important factors include the level of trauma to the vertebrae, whether the individual sustained additional trauma to the rest of the body, position of the affected vertebrae, if the fracture is stable or unstable, and individual's health status at the time of trauma. Fractures that heal with significant deformity may be incompatible with heavy work. The nature of an individual's work, age, complications from the injury, and stability of the fracture after treatment will also influence the length of disability.

Medical Codes

ICD-9-CM:
805.0 - Closed Fracture of Cervical Spine without Mention of Spinal Cord Injury
805.00 - Closed Fracture of Cervical Spine, Unspecified Level, without Mention of Spinal Cord Injury
805.01 - Closed Fracture of First Cervical Vertebra without Mention of Spinal Cord Injury
805.02 - Closed Fracture of Second Cervical Vertebra without Mention of Spinal Cord Injury
805.03 - Closed Fracture of Third Cervical Vertebra without Mention of Spinal Cord Injury
805.04 - Closed Fracture of Fourth Cervical Vertebra without Mention of Spinal Cord Injury
805.05 - Closed Fracture of Fifth Cervical Vertebra without Mention of Spinal Cord Injury
805.06 - Closed Fracture of Sixth Cervical Vertebra without Mention of Spinal Cord Injury, Closed
805.07 - Closed Fracture of Seventh Cervical Vertebra without Mention of Spinal Cord Injury, Closed
805.08 - Closed Fracture of Multiple Cervical Vertebra without Mention of Spinal Cord Injury
805.1 - Open Fracture of Cervical Spine without Mention of Spinal Cord Injury
805.10 - Open Fracture of Cervical Spine, Unspecified Level, without Mention of Spinal Cord Injury
805.11 - Open Fracture of First Cervical Vertebra without Mention of Spinal Cord Injury
805.12 - Open Fracture of Second Cervical Vertebra without Mention of Spinal Cord Injury
805.13 - Open Fracture of Third Cervical Vertebra without Mention of Spinal Cord Injury
805.14 - Open Fracture of Fourth Cervical Vertebra without Mention of Spinal Cord Injury
805.15 - Open Fracture of Fifth Cervical Vertebra without Mention of Spinal Cord Injury
805.16 - Open Fracture of Sixth Cervical Vertebra without Mention of Spinal Cord Injury
805.17 - Open Fracture of Seventh Cervical Vertebra without Mention of Spinal Cord Injury
805.18 - Open Fracture of Multiple Cervical Vertebra without Mention of Spinal Cord Injury

Overview

Fracture of the cervical spine is a break in one or more of the seven bones (vertebrae C1 through C7) in the neck (cervical) region. Cervical spine injuries primarily are the result of traumatic injuries to the head and neck. The most frequent injuries result from motor vehicle collisions, falls, diving into shallow water, and gunshot wounds to the neck. An individual with an unstable fracture is at risk for spinal cord injury unless the fracture is stabilized. Fractures often occur in conjunction with dislocations in which the vertebral segments become dislodged and the overall alignment of the spine changes. Traumatic spondylolisthesis of C2 (hangman's fracture) is a type of fracture-dislocation.

The majority of cervical spine fractures occur at either the upper or lower end of the cervical spine. Fracture of the C1 or C2 vertebra can be fatal. Cervical spine fracture(s) may cause instability, which can lead to spinal cord compression and neurologic disability.

Types of cervical spine fracture from flexion (head bends forward) injuries of the neck include simple wedge compression fracture, anterior vertebral body fracture (teardrop fragment), and atlantooccipital or atlantoaxial fracture with dislocation. Common types of cervical spine fracture from extension (head bends backwards) injuries of the neck are named according to anatomic location and include pillar fracture, posterior neural arch fracture, and extension teardrop fracture. Upper cervical fractures at C1 (Jefferson burst fracture) or C2 may result from compression injuries of the neck. Fractures of the C2 odontoid process are associated with other types of upper cervical fractures.

Incidence and Prevalence: The incidence of all spinal injuries in the US is about 11,000 per year, resulting in about 6000 deaths and 5000 new cases of quadriplegia (Davenport). The overall incidence of cervical spinal fracture without spinal cord injury is 3.0% (Hertner). Motor vehicle accidents account for 50% of injuries; falls account for 20%; sports-related activities account for 15%; and other high-velocity accidents account for 15% (Goodrich; Davenport).

C1 vertebral fractures represent 10% of cervical spine injuries and 2% of all spine injuries (Foster). C2 fractures account for 33% of fractures, and C6 or C7 fractures account for 50%; fractures of the odontoid process of C2 represent 15% of all cervical spine injuries (Boyarsky).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who participate in high-impact sports such as diving, equestrian activities, football, gymnastics, skiing, and hang gliding are at risk for cervical fractures. The male to female ratio for cervical fracture is 4:1, and 80% of individuals are between 18 to 25 years of age (Davenport).

Source: Medical Disability Advisor



Diagnosis

History: Fracture or dislocation of the cervical spine should be suspected in any individual who complains of pain in the neck area following an injury. If the individual is able to talk, a careful history should be obtained with details regarding the nature of the accident, especially the mechanism of injury. If the individual is not able to talk, statements from witnesses can be helpful. Individuals may report being thrown from a vehicle and striking their head. Individuals will report pain with attempted neck movement.

Physical exam: In any case of suspected neck injury, no examination for neck range of motion should be undertaken until screening x-rays are complete. Following x-rays, extensive neurological testing of reflexes, sensation, and upper and lower extremity movement should be performed to rule out spinal cord injury. Common findings on physical examination include: spinal shock with lack of muscle tone, loss of reflexes, loss of bowel/bladder control; neurogenic shock with slow heartbeat, low blood pressure, flushed peripheral skin; and autonomic dysfunction with low body temperature, slowing of intestinal movements and urinary retention.

A neurosurgeon or orthopedic spine surgeon must examine the individual frequently in the days following the injury. The neurologist will determine which limbs and other parts of the body are unresponsive to stimuli and whether function is likely to return.

Tests: Imaging studies such as x-ray, CT, and MRI are used to determine the site and extent of the fracture. A standard trauma series of x-rays usually includes 5 views of the neck: from front to back (anteroposterior or AP), 2 special side-to-side views (oblique and cross table lateral), a view from the axilla (swimmer’s), and a view through the open mouth (odontoid). CT is more sensitive and is replacing plain x-ray in many medical centers. The same 5 views are often used. MRI is very useful for soft tissue injuries and avoids the potential for injury with movement of the neck. However if MRI is unavailable, flexion-extension x-rays may be necessary. MRI is also helpful in the detection of disc displacement or nerve root injury. Neurological studies, including electromyography (EMG) and nerve conduction tests, may be performed.

Source: Medical Disability Advisor



Treatment

When a cervical spine fracture is suspected, the first step should be complete immobilization of the neck to prevent any further damage to the spinal cord. Transportation to the nearest trauma center or emergency department should occur as soon as feasible. In the emergency department, the individual is usually placed in tongs with traction as soon as a misalignment of the cervical spine is identified.

Specific treatment depends on which of the seven cervical vertebrae are damaged and the nature of the fracture. Management of acute cervical spine injuries without neurologic deficits includes procedures to realign the bony fragments. The primary indications for surgery include misalignment of the spine and progressive neurologic deterioration with compression from bone or disc fragments.

Corticosteroids may be given to individuals with blunt cervical spine injury and neurological symptoms if treatment can be initiated within the first 8 hours after injury. Pain control is important and narcotic medications also may be given. Histamine 2 blockers (H2) blockers are widely used to prevent the development of stress ulcers in the gastrointestinal tract. Prevention of deep vein thrombosis and pulmonary embolism with compression stockings or medication also is important in individuals with neurologic compromise. After surgery, early mobilization and return to independence is important in the prevention of disability.

Source: Medical Disability Advisor



Prognosis

The prognosis for individuals with cervical spine fracture covers the spectrum from complete recovery of function after the fracture heals to total paralysis (quadriplegia) if spinal cord injury is present. Minor cervical fractures without spinal cord injury including isolated compression fractures, spinous process fractures, or isolated lamina fractures have an excellent prognosis. Cervical spine fractures without spinal cord injury that have been stabilized surgically generally have a good prognosis, although head and neck motion may be restricted by as much as 50%following upper cervical stabilization (Foster). Cervical fracture repair accomplished solely by internal fixation is usually unsuccessful; internal fixation accompanied by cervical fusion improves the prognosis.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation guidelines for a fracture of the cervical spine will be based on the fracture type and its management (operative, nonoperative) (Bucholz). The stability of the fracture must be ascertained prior to proceeding with rehabilitation.

If the spinal cord is intact, the rehabilitation protocol depends on the stability of the fracture which may require 6 to 12 weeks of healing. The primary goal is to restore function and to control pain (Salter). Modalities such as cold and heat may help to relieve pain and muscle discomfort. Supervised range of motion and strengthening exercises of the neck, upper extremities, and upper trunk should be initiated when indicated. Simultaneously, individuals should be instructed in neck stabilization and postural exercises.

In addition to undergoing supervised rehabilitation, the individual should be instructed in a home exercise program to be practiced daily and continued independently after the completion of rehabilitation.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistFracture, Cervical Spine (Without Spinal Cord Injury)
Physical TherapistUp to 16 visits within 8 weeks
Surgical
SpecialistFracture, Cervical Spine (Without Spinal Cord Injury)
Physical TherapistUp to 12 visits within 6 weeks
Note on Nonsurgical Guidelines: Rehabilitation may not begin until tissue healing, about 6 to 8 weeks after fracture.
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

Any vertebral injury can lead to serious consequences because of the spinal cord’s position inside the vertebrae; damage to the spinal cord can result in paralysis or death. Complications include infection after open fractures or open reduction, nerve damage with displaced fractures or fracture dislocations, and bone healing with faulty alignment (malunion). Vertebral artery injuries may occur with cervical fractures at the C1 or C2 level, and persistent instability of the upper cervical spine can lead to brainstem injury and death.

Transient loss of function with searing pain down one arm ("stingers" or "burners") following cervical injury can occur without cervical fracture or spinal cord injury.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual with a cervical fracture without spinal cord injury will have restrictions on neck extension and flexion. This could include no overhead work, no ground-level work, no lifting until the fracture heals The individual will need time off for visits to physicians and therapists. The individual may take narcotic medication for pain. Company policy on medication usage should be reviewed to determine if narcotic pain medication use is compatible with job safety and function.

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?
  • Was individual’s neck immobilized as soon as possible after the injury?
  • Did individual show any signs of immediate paralysis?
  • Was individual transported as quickly as possible to the nearest trauma center or emergency department?
  • Which vertebrae (C1 through C7) in the cervical region were injured?
  • Does individual have a stable or an unstable fracture?
  • Does individual have history of previous injuries, paralysis, weakness, or spondylosis?
  • Has individual been examined by a neurologist?
  • Has individual had x-rays, CT scan, MRI?
  • Has EMG or other neurological testing been done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was individual's cervical spine stabilized with a hard cervical collar or halo body vest?
  • Were any bony fragments realigned as quickly as possible?
  • Was any joint dislocation reduced as quickly as possible?
  • Did individual have a spinal cord injury? Was neurological deficit identified and treated?

Regarding prognosis:

  • Has individual participated in physical therapy and a home exercise program?
  • Is occupational therapist working with physical therapist to maximize the individual's recovery?
  • Is there a psychologist or psychiatrist on the treatment team?
  • Does individual have any conditions that may affect the ability to recover?
  • Has individual developed any complications such as infection, nerve damage, or malunion?
  • Is pain medication or pain-induced sleep deprivation causing cognitive impairment or inappropriate sleepiness during work hours?

Source: Medical Disability Advisor



References

Cited

Boyarsky, Igor, and Gary Godorov. "C2 Fractures." eMedicine. Eds. James F. Kellam, et al. 30 Jun. 2003. Medscape. 11 Oct. 2004 <http://emedicine.com/orthoped/topic597.htm>.

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

Davenport, Moria, et al. "Fracture, Cervical Spine." eMedicine. Eds. Mark Louden, et al. 1 Apr. 2008. Medscape. 22 Dec. 2008 <http://emedicine.com/emerg/topic189.htm>.

Foster, Mark R. "C1 Fractures." eMedicine. Ed. James F. Kellam. 19 Dec. 2003. Medscape. 11 Oct. 2004 <http://emedicine.com/orthoped/topic31.htm>.

Goodrich, Jacob, and Thad Riddle. "Lower Cervical Spine Fractures and Dislocations." eMedicine. Ed. Daniel Riew. 21 May. 2002. Medscape. 11 Oct. 2004 <http://emedicine.com/orthoped/topic175.htm>.

Hertner, George L., and Nathaniel Johnson Stewart. "Cervical Spine Acute Bony Injuries." eMedicine. Eds. Janos P. Ertl, et al. 9 Jan. 2004. Medscape. 11 Oct. 2004 <http://emedicine.com/sports/topic22.htm>.

Salter, Robert, ed. Textbook of Disorders and Injuries of the Musculoskeletal System. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 1999.

Source: Medical Disability Advisor






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