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, Vertebra


Related Terms

  • Broken Back
  • Cervical Fracture
  • Lumbar Fracture
  • Spine Fracture
  • Thoraco-lumbar Fracture

Differential Diagnosis

Specialists

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

Factors Influencing Duration

Factors influencing the length of disability include the presence of spinal cord injury, the severity and location of the fracture, the individual's age, any associated complications, the presence of comorbid illness or concomitant injuries, and the stability of the fracture. Progressive deformity of unstable fractures may interfere with effective rehabilitation and increase duration.

Medical Codes

ICD-9-CM:
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
805.10 - 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
805.2 - Closed Fracture of Thoracic Spine without Mention of Spinal Cord Injury
805.3 - Open Fracture of Thoracic Spine without Mention of Spinal Cord Injury
805.4 - Closed Fracture of Lumbar Spine without Mention of Spinal Cord Injury
805.5 - Open Fracture of Lumbar Spine without Mention of Spinal Cord Injury
805.6 - Closed Fracture of Sacrum and Coccyx without Mention of Spinal Cord Injury
805.7 - Open Fracture of Sacrum and Coccyx without Mention of Spinal Cord Injury
805.8 - Closed Fracture of Vertebral Column, Unspecified, without Mention of Spinal Cord Injury
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
806.20 - Closed Fracture of T1-T6 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.21 - Closed Fracture of T1-T6 Level of Vertebral Column with Complete Lesion of Cord
806.22 - Closed Fracture of T1-T6 Level of Vertebral Column with Anterior Cord Syndrome
806.23 - Closed Fracture of T1-T6 Level of Vertebral Column with Central Cord Syndrome
806.24 - Closed Fracture of T1-T6 Level of Vertebral Column with Other Specified Spinal Cord Injury
806.25 - Closed Fracture of T7-T12 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.26 - Closed Fracture of T7-T12 Level of Vertebral Column with Complete Lesion of Cord
806.27 - Closed Fracture of T7-T12 Level of Vertebral Column with Anterior Cord Syndrome
806.28 - Closed Fracture of T7-T12 Level of Vertebral Column with Central Cord Syndrome
806.29 - Closed Fracture of T7-T12 Level of Vertebral Column with Other Specified Spinal Cord Injury
806.30 - Open Fracture of T1-T6 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.31 - Open Fracture of T1-T6 Level of Vertebral Column with Complete Lesion of Cord
806.32 - Open Fracture of T1-T6 Level of Vertebral Column with Anterior Cord Syndrome
806.33 - Open Fracture of T1-T6 Level of Vertebral Column with Central Cord Syndrome
806.34 - Open Fracture of T1-T6 Level of Vertebral Column with Other Specified Spinal Cord Injury
806.35 - Open Fracture of T7-T12 Level of Vertebral Column with Unspecified Spinal Cord Injury
806.36 - Open Fracture of T7-T12 Level of Vertebral Column with Complete Lesion of Cord
806.37 - Open Fracture of T7-T12 Level of Vertebral Column with Anterior Cord Syndrome
806.38 - Open Fracture of T7-T12 Level of Vertebral Column with Central Cord Syndrome
806.39 - Fracture, T7-T12 Level of Vertebral Column with Other Specified Spinal Cord Injury, Open
806.4 - Closed Fracture of Lumbar Spine with Spinal Cord Injury
806.5 - Open Fracture of Lumbar Spine with Spinal Cord Injury
806.60 - Closed Fracture of Sacrum and Coccyx with Unspecified Spinal Cord Injury
806.61 - Closed Fracture of Sacrum and Coccyx with Complete Cauda Equina Lesion
806.62 - Closed Fracture of Sacrum and Coccyx with Other Cauda Equina Lesion
806.69 - Closed Fracture of Sacrum and Coccyx with Other Spinal Cord Injury
806.70 - Open Fracture of Sacrum and Coccyx with Unspecified Spinal Cord Injury
806.71 - Open Fracture of Sacrum and Coccyx with Complete Cauda Equina Lesion
806.72 - Open Fracture of Sacrum and Coccyx with Other Cauda Equina Lesion
806.79 - Open Fracture of Sacrum and Coccyx with Other Spinal Cord Injury

Overview

© Reed Group
Fracture of the vertebra refers to a break in any of the bones (vertebrae) of the spinal column. The spine is made up of seven cervical vertebrae (C 1 through C7 in the neck), twelve thoracic vertebrae (T1 through T12 in the upper back), five lumbar vertebrae (L1 through L5 in the lower back), five sacral vertebrae that are fused together at the end of the spine, and the coccyx (tailbone). The thoracic spine is the longest portion of the spine, and there is a more limited vascular supply to the spinal cord, compared to other areas of the spine.

The spine is described in terms of three load-bearing columns (as viewed from the side) that contribute to spinal stability: the anterior column at the front, the middle column, and the posterior column at the back.

Vertebral fractures may result from a traumatic injury or indirect stress due to excessive spinal flexing, extension, rotation, or bending.

Vertebral fractures may be classified according to type and location. There are several types of vertebral fractures based on the mechanism of injury: compression fractures, flexion-distraction fractures, burst fractures, and fracture-dislocations. Compression fractures (also called wedge fractures), which are the most common type of thoraco-lumbar fracture, occur when the anterior portion of the vertebral column is compressed. Flexion-distraction fractures occur as the result of extreme force placed on vertebrae by sudden stopping or rapid deceleration, as in seatbelt injury during an automobile accident (Chance or seatbelt fracture); the posterior column is injured in these fractures, including ligamentous and/or bony components. A classic Chance or seatbelt fracture is a horizontal break in the bones of the posterior and middle columns and is usually considered stable.

Burst fractures result from extreme force applied straight down on the vertebrae (e.g., when an individual falls from a height and lands on the feet or buttocks) and involve compression of both the anterior and middle columns; these are stable fractures if the posterior column remains intact but can be unstable if the posterior column has sustained injury. Fracture-dislocations are the result of a twisting or shearing force (rotation, distraction, and shear injuries) causing simultaneous fracture and displacement of the vertebrae; all three columns of the spine can be affected, with varying degrees of anterior column injury. These are unstable fractures commonly associated with neurologic deficit.

Half of vertebral fractures occur in the cervical spine; the rest occur in the thoracic, lumbar, and sacral areas (Reiter). Sports activities associated with the highest risk of cervical fracture include diving, equestrian activities, football, gymnastics, skiing, and hang gliding. Fractures of the raised bony hooks, or spinal processes, on the superior surface of the vertebral body (uncinate process fractures) can occur in the cervical spine and are mostly associated with a side impact; they can also occur during a rear impact when the subject's head is rotated during the impact.

One-third of vertebral fractures result from motor vehicle accidents, another 25% are caused by violence, and falls or recreational sports cause the remaining injuries (Reiter).

Incidence and Prevalence: Approximately 150,000 people sustain fractures to the vertebral column each year; the majority are in the lumbar spine and occur without spinal cord injury (Vinas 2008; Vinas 2004). Each year 11,000 new spinal cord injuries are estimated to occur, contributing to a total of 250,000 individuals with spinal cord injuries (Reiter). In the US, cervical spine injuries result in approximately 6,000 deaths and 5,000 new cases of quadriplegia each year (Davenport).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Young adult males, the population most frequently involved in automobile accidents, sports injuries, and violence, are at greatest risk of vertebral injury: about 80% of those with vertebral fractures are male, and approximately 55% of those injured are 16 to 30 years old (Reiter).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may be free of symptoms (asymptomatic), or they may report weakness, transient paralysis, numbness or tingling (paresthesia) of the extremities, and/or loss of urinary and/or bowel continence, suggesting possible spinal cord and/or nerve root injury. Individuals with cervical spine fractures may report posterior neck pain; limited range of motion associated with pain; and weakness, numbness, or tingling along the affected nerve roots and in the upper extremities. Individuals with thoraco-lumbar fractures may report pain, limited range of motion, and lack of feeling or strength in the saddle area and/or legs, depending on the level of injury. Pain may not begin until hours after the injury. A detailed history will include the mechanism of injury, relative force sustained and type of force (compression, flexion, extension, rotation, shear, distraction, or a combination), prior spinal injury, and any neurologic changes noted at the time of injury. A general health history should include prior diagnosis and treatment for metabolic or endocrine conditions that could contribute to pathologic fracture.

Physical exam: If an accident has caused injury, immediate attention will be given to the individual’s airway, breathing, and blood circulation. Swelling of the soft tissue may be present around the site of the vertebral fracture. Touching the area (palpation) may reveal tenderness. The cranium and entire spine will be examined. Deformities, abrasions, and bruising may be present over affected areas along the length of the spine. Individuals with thoraco-lumbar fractures may show visible deformity if the fracture is complete and is severe enough to distort normal back contours. Palpation of the parts of the spine that are easily felt as the bumps down the center of the back (spinous processes) may reveal shifting of the vertebral bodies. Examination of the cervical and thoraco-lumbar spine may be deferred until x-rays have documented the absence or presence of fractures that are potentially unstable. Inspection of the abdomen may reveal trauma such as lap seatbelt markings, which are often associated with lumbosacral spine injury.

Neurologic examination may be done to evaluate motor and sensory responses, reflexes, and coordination. The initial level of spinal cord or nerve root injury may be determined based upon neurologic examination findings.

Patients whose injuries were caused by significant force will require examination for associated injuries such as pelvic fractures; limb fractures; and pulmonary, cardiac, or abdominal organ injury.

Tests: X-rays (anteroposterior [AP] and lateral views), CT scans, and MRI are the usual methods used to diagnose spinal fractures. Diagnosis of uncinate process fractures can be made with an AP view of the lower cervical spine.

MRI permits visualization of the spinal cord and is able to detect both soft tissue and bone injury. Neurologic tests assess motor and sensory damage, coordination, and reflexes. Depending on the severity of the fracture and associated injuries, blood tests may be ordered to assess damage to other organ systems. Hemodynamic stability may be monitored, especially if spinal cord injury is suspected or confirmed.

Source: Medical Disability Advisor



Treatment

Generally speaking, treatment consists of nonsurgical or surgical intervention. The first step in treatment of any suspected vertebral fracture is immobilization to protect the spinal cord. Once the location of the fracture and the extent of spinal cord injury are determined (via x-rays, CT scan, and/or MRI), treatment will depend on the type of fracture, its location, and any nerve damage and may vary from a conservative approach to surgical intervention. Patients who have stable fractures without nerve root or spinal cord involvement and those who have incomplete neurologic injury (nerve compression but no paralysis) will be evaluated for decompressive surgery and possible fusion. Surgery may help retain neurologic function in incomplete neurologic injury but is controversial for patients with complete neurologic deficit with paraplegia, in the absence of unstable fractures. Hemodynamically unstable patients are not treated surgically until they have been stabilized. Elderly individuals or those with comorbid conditions that compromise cardiac or pulmonary function may not be candidates for surgery.

One of the factors considered in determining whether to treat an injury nonsurgically or surgically is the stability of the fracture. In general, if a fracture is stable, the affected area (neck or back) is immobilized with the use of orthotics (braces or corsets) or casts. Mild thoraco-lumbar fractures with a low risk of progression usually require only minimally immobilizing orthoses (e.g., a lumbosacral corset) to restrict gross trunk motion. Significant injuries, such as severe compression fractures and moderate burst fractures, may require a more rigid brace. Milder cervical fractures may be treated with traction, applied to slowly manipulate broken bones back to their proper position.

Another nonsurgical option for significant deformity is to stabilize the vertebral fracture by percutaneously injecting bone cement (polymethyl methacrylate) into the vertebral segments (vertebroplasty), or to reduce the deformity and then stabilize by injecting bone cement (kyphoplasty).

Severe injuries, such as fracture-dislocations and multilevel burst fractures, are usually unstable, and orthotics would not provide enough support to ensure protection from further injury. Unstable fractures that produce deformity generally require surgical decompression, stabilization, and fusion (with pedicle screws, rods, and/or hooks). There is some evidence that conservative treatment of well-selected unstable fractures may provide outcomes as beneficial as those resulting from surgery; however, this choice is highly individualized and depends on a number of factors, including the potential for neurological injury.

Following immobilization procedures, treatment consists of bed rest, ice (or heat), and other modalities. Medications may include narcotic pain relievers for severe pain, over-the-counter analgesics (e.g., acetaminophen) for milder pain, antibiotics to fight infection if the skin was broken or if surgery was performed, and stool softeners, if necessary, to prevent constipation due to inactivity. Prophylactic corticosteroids are used when there is the possibility of spinal cord injury (to reduce swelling and minimize damage).

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Low Back Disorders
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

The outcome depends upon the severity of the fracture, the amount of residual deformity, and the extent of accompanying neurological damage. Individuals with stable vertebral fractures and no neurologic deficit or concomitant injury typically have a good outcome after a short period of bed rest and early ambulation, with or without orthosis.

The probability of complete healing and no pain following cervical fractures with no neurological damage is very good with conservative treatment. The average healing time is 6 to 12 weeks in traction, followed by 2 months in a neck brace. Cervical spine injury usually has a shorter duration than vertebral injury in the thoracic, lumbar, or sacral regions.

Stable thoraco-lumbar fractures have a very good prognosis and usually heal satisfactorily within 6 to 8 weeks with conservative treatment. However, studies have demonstrated that symptoms may last as long as 3 to 9 months before return to full function, although few individuals have adverse outcomes even with prolonged symptoms (Levine). The functional outcome for those treated nonoperatively for vertebral fracture with neurologic symptoms is reasonably good.

The lumbar spine is integral to mobility and overall spinal alignment, which may be disrupted by residual deformity. Fracture of lower lumbar vertebrae, treated with or without fusion, can lead to development of late symptoms and degenerative changes.

Surgery (decompression, stabilization, and fusion; or corpectomy and fusion) is usually successful at immobilizing the vertebral column but may be associated with residual pain and/or reduced mobility in the affected area of the back. Because there is the potential for varying degrees of paralysis if the spinal cord is injured, the prognosis in these cases varies widely (from full recovery to total paralysis).

Source: Medical Disability Advisor



Rehabilitation

Rehabilitative therapy for vertebral fractures differs based on location, severity, and cause of fracture. Deviations in therapeutic procedures are also dictated by mode of fracture stabilization.

Individuals who require operative spinal stabilization through vertebral fusion or other fixation methods will engage in similar routines as those who received nonoperative stabilization. However, their rate of progress and chosen exercises will take into account the limitations imposed by the operative procedure. In either case, therapeutic exercises for muscle groups not immobilized are initiated immediately to increase spine alignment and healing.

In order to alleviate stress on the spine, the individual may engage in short arc exercises. Ice massage or heat may be applied to the fracture site if the area is not in a cast. Hydrotherapy and functional exercises may be introduced to help restore normal gait pattern. Progressive resistive exercises to strengthen the erector spinae and other lower back muscles may also be taught.

Strength and flexibility must be accompanied by functional training so the individual is able to maintain trunk control through all movements.

In general, for fractures with neurologic deficit, most rehabilitation programs include progressive physical and occupational therapy over a period of 12 to 24 weeks. Vocational rehabilitation may be necessary for more impaired individuals. Complete healing time for the vertebral fractures is between 6 and 8 weeks or when the union of vertebral bones is complete.

Source: Medical Disability Advisor



Complications

The most serious complication of vertebral fractures is spinal cord injury, which can result in paralysis. Approximately 39% of cervical fractures have some degree of associated neurologic deficit (Davenport). Other complications of vertebral fractures include infection, nerve damage in displaced fractures, faulty alignment of the healed vertebrae (malunion), chronic obstructive pulmonary disease (COPD), gastrointestinal disease, further instability or osteoarthritis in the area, impaired blood supply to the fracture site, and avascular necrosis. Chronic pain as a result of vertebral fracture can lead to depression. Vertebral fractures can cause postural changes, leading to the development of hunchback (kyphosis). More severe kyphosis as a complication of high thoracic injury may cause the individual to hyperextend the neck, leading to neck pain and muscle fatigue. Kyphosis can also limit total lung capacity and exercise tolerance. Cervical spine fractures may be complicated by spinal shock, neurogenic shock, complete and incomplete cord syndromes, Brown-Sequard syndrome, and Horner syndrome. The diaphragm, which functions significantly in respiration, may be affected by nerve injury sustained in cervical spine fracture (C3 to C5), predisposing the individual to lung problems such as atelectasis and recurrent pneumonia. Mechanically unstable thoracic and lumbar vertebral fractures may develop progressive deformity despite bracing.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

An individual with a fracture and no spinal cord injury will be restricted in most physical activities for several weeks after the injury. Physical labor such as lifting, running, walking, standing for extended periods of time, carrying, bending, climbing ladders, and twisting should be avoided. Individuals who require surgical intervention that includes fusion of the vertebral column for stability may be permanently disabled from certain types of physical activities. The individual may need frequent rest breaks (recline) throughout the day and time off for physical therapy.

Numerous work restrictions and accommodations may be necessary if the spinal cord was injured, and the extent required will be dependent upon the severity of the injury. The individual may be permanently disabled from performing duties requiring physical strength or dexterity. In extreme cases (for example, in cases of paralysis), the workplace will need to be wheelchair-accessible and will require standard facilities for disabled persons.

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 individual report recent trauma? What was the mechanism of injury?
  • Did individual present with symptoms consistent with a vertebral fracture?
  • Did individual present with neurological deficits?
  • Was the fracture confirmed with an x-ray?
  • Was a CT scan done to rule out spinal cord injury?
  • Was MRI performed to evaluate the extent of spinal cord, soft tissue and bone injury?
  • If the diagnosis was uncertain, were other conditions with similar symptoms ruled out?
  • Does individual have comorbid illness?
  • Were concomitant injuries present as a result of trauma?

Regarding treatment:

  • Were analgesics effective in controlling pain? If not, were alternative pain management techniques (relaxation exercises, hydrotherapy, visualization) tried?
  • Was individual compliant with treatment recommendations?
  • Was either vertebroplasty or kyphoplasty performed to stabilize the spine?
  • Was surgery performed? What type?
  • Would the individual benefit from consultation by a specialist (neurosurgeon, orthopedic surgeon, physiatrist)?
  • Did individual participate in rehabilitation as recommended?
  • Are there barriers preventing individual from participating in rehabilitation (insurance limitations, lack of transportation, lack of motivation, pain, depression)?

Regarding prognosis:

  • Was the fracture associated with injury to the spinal cord?
  • What was the expected outcome?
  • Does individual have any comorbid conditions that may impact ability to recover?
  • Did individual develop any complications or have any concurrent injuries that may influence length of disability?
  • Have appropriate work accommodations been considered?
  • Would individual benefit from psychological counseling?

Source: Medical Disability Advisor



References

Cited

Davenport, Moria, et al. "Fracture, Cervical Spine." eMedicine. Eds. Mark Louden, et al. 1 Apr. 2008. Medscape. 26 Jan. 2009 <http://emedicine.com/emerg/topic189.htm>.

Levine, A. M. "Low Lumbar Fractures." Skeletal Trauma: Basic Science, Management, and Reconstruction. Eds. Bruce. D. Browner, et al. 3rd ed. 2 vols. Philadelphia: Elsevier, Inc., 2003.

Reiter, Timothy G., et al. "Vertebral Fracture." eMedicine. Eds. Michael G. Nosko, et al. 8 Jul. 2004. Medscape. 26 Jan. 2009 <emedicine.com/med/topic2895.htm>.

Vinas, Federico C. "Lumbar Spine Fractures and Dislocation." eMedicine. Eds. Lee H. Riley, et al. 8 Jul. 2004. Medscape. 26 Jan. 2009 <http://emedicine.com/orthoped/topic176.htm>.

Vinas, Federico C. "Lumbosacral Spine Acute Bony Injuries." eMedicine. Eds. A. D. Perron, et al. 8 Jul. 2008. Medscape. 26 Jan. 2009 <http://emedicine.com/sports/topic67.htm>.

Source: Medical Disability Advisor






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