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.

Laminectomy or Laminotomy


Related Terms

  • Foraminotomy
  • Lumbar Laminectomy
  • Rachiotomy
  • Spondylotomy

Specialists

  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that may influence length of disability include the extent of the laminectomy or laminotomy procedure; surgical site within the spinal column; underlying cause of the disorder and its severity; procedures performed concurrently with laminectomy, such as discectomy or fusion; occurrence of complications; individual's job requirements; individual's ability to modify work activities; and individual's compliance with treatment and rehabilitation.

The duration of disability is highly variable, depending on whether the root compression is cervical, thoracic, lumbar, or sacral; whether the disorder involves the spinal cord; and whether the individual's job classification is sedentary, light, medium, heavy, or very heavy work. Duration assumes no persisting spinal cord or cauda equina deficit.

Medical Codes

ICD-9-CM:
03.02 - Reopening of Laminectomy Site
03.09 - Exploration and Decompression of Spinal Canal, Other: Decompression: Laminectomy or Laminotomy; Expansile Laminoplasty; Exploration of Spinal Nerve Root; Foraminotomy

Overview

Laminectomy is a surgical procedure designed to relieve pressure on nerves or the spinal cord in either the back or the neck. This procedure involves the complete removal of the back portion of the spinal vertebrae (lamina) and attached ligaments. It is often performed to relieve pressure on a nerve root that is causing radiating pain and weakness. This condition is often referred to as inflammation of a nerve root (radiculitis) or pathology of the nerve root (radiculopathy).

A laminectomy is frequently confused with a laminotomy, which is only the partial removal of the lamina and attached ligaments. Laminectomies and laminotomies are often performed in the course of a number of operations on the spinal canal, such as removal of a ruptured disc.

During both procedures, the surgeon gains access to the spinal canal, spinal cord, and nerve roots to remove the source of pain and pressure, such as a slipped disc, bone spurs, or damaged or thickened ligaments.

Depending on where the laminectomy or laminotomy is performed, different terms are used to describe it. In the neck, the term used is cervical laminectomy or laminotomy; in the chest, thoracic laminectomy or laminotomy; in the lower spine, lumbar laminectomy or laminotomy; and in the fused base of the spine (sacrum), sacral. Most laminectomies and laminotomies are performed in the cervical or lumbar regions.

Source: Medical Disability Advisor



Reason for Procedure

The primary reason for performing a laminectomy or laminotomy is to gain access to the spinal canal and the neural elements within the canal. This may be done either to decompress the neural elements or to remove a tumor or other pathology in the spinal canal. The choice of procedure depends on the location, level, and size of the disc herniation or other structural problem.

A laminectomy or laminotomy may be performed to relieve pressure on the spinal cord or the nerves that branch from it. This condition is often described as nerve root compression or a "pinched nerve" and may cause back and leg pain. Nerve root compression can result from different structural problems, either individually or in combination. These include a ruptured disc (also called slipped, herniated, or prolapsed disc), deterioration or "wear and tear" of multiple discs with bone spur formation (degenerative disc disease, or spondylosis), spinal stenosis, or scar tissue. In a laminectomy, the lamina is removed to allow visualization of the underlying nerve root and disc; the removal of the disc (discectomy) may be performed using this approach.

The procedure may also be performed for surgery on the spinal cord itself, for removal of a tumor of the spinal cord, or other pathology in the spinal canal.

In general, laminectomy/laminotomy, with or without discectomy, is performed if there are signs of nerve root compression; it is expected that the individual's symptoms will improve when pressure on the nerve root is relieved. Signs and symptoms of nerve root compression include pain in the distribution of a nerve root; significant weakness; loss of deep tendon reflexes; EMG or nerve conduction velocity testing evidence of nerve root injury; and MRI or CT evidence of a disc herniation, bone spur, or stenosis compressing the nerve root. Test results should coincide with the side and location of the individual's pain and other symptoms.

Source: Medical Disability Advisor



How Procedure is Performed

Laminectomies and laminotomies are performed under general anesthesia. The individual is positioned face down on a well-padded laminectomy frame or spinal board. X-rays may be taken to confirm the location. An incision is made in the middle of the back or neck over the area of involvement. The muscles beneath the skin are spread apart to expose the laminae overlying the spinal cord and nerve roots. Bone is removed using a bone cutter or air drill. As noted above, the amount of bone removed will depend on the amount of exposure or decompression necessary. The neural elements can be seen after the laminectomy/laminotomy has been performed. Decompression may be accomplished with a laminectomy/laminotomy alone, or a discectomy may also be performed through this approach if indicated.

The laminectomy procedure may be combined with the foraminotomy procedure. During a foraminotomy, the bony canal through which the nerves pass as they leave the spinal cord is widened. The foraminotomy, like the laminectomy procedure, relieves pressure on the nerves.

The laminectomy procedure may also be combined with a facetectomy procedure. During a facetectomy, part of the medial, usually superior bony facet joint, may be excised to allow more room for the nerve root. Up to 50% of the facet joint may be removed without compromising spinal stability. If a total facetectomy is required to decompress the nerve root, the spine will require stabilization with fusion.

An operating microscope or special magnifying lenses may be used to perform a discectomy. Some of the ligament under the lamina (ligamentum flavum) is removed, and the nerve root is carefully moved. The ruptured disc is then identified and removed from beneath (in front of) the nerve root. The disc space may then be entered and additional loose disc material removed.

If enough bone is removed to cause weakening of the spine, the bone is strengthened with the installment of metal rods or bone grafts (fusion) harvested from the hip bone (iliac crest).

Source: Medical Disability Advisor



Prognosis

The predicted outcome of laminectomies and laminotomies is contingent on the history of the disorder, extent of damage, number of vertebrae involved, and location within the spinal column. The success of discectomy in relieving back pain and symptoms involving the limbs depends heavily on patient selection. Improvement after laminectomy and laminotomy includes decreased pain, often with decreased pins-and-needles sensation (tingling or numbness) and decreased weakness, and improved function.

Review of the literature suggests that up to 85% of individuals have good to excellent results following lumbar laminectomy for disc excision. Between 25% and 75% of individuals improve following laminectomy, between 15% and 30% are unchanged, and between 5% and 50% worsen, while the incidence of recurring disc herniation following laminectomy with discectomy is 5% to 37% (Choy).

Source: Medical Disability Advisor



Rehabilitation

After laminectomy or laminotomy, individuals wear a low back brace or cervical collar for a period of 2 to 5 months. Individuals undergo inpatient occupational and physical therapy for 3 to 5 days. Treatment focuses on independence in taking the brace off and on. Individuals learn to safely transfer to and from the bed, chair, shower, and toilet.

In the case of lumbar laminectomy, individuals learn to ambulate with a walker and negotiate stairs. Physical therapists instruct individuals to perform abdominal stabilization exercises and leg and arm strengthening exercises.

Occupational therapists teach individuals dressing, toileting, and showering strategies with the use of adaptive equipment as needed to avoid forward bending of the spine.

Outpatient physical therapy begins approximately 1 month after surgery according to the operating physician's protocol. Therapists initially focus on pain control and the reduction of swelling. Modalities such as ice or heat may be used to reduce pain and swelling and decrease muscle spasm.

Increasing range of motion is the second objective of rehabilitation. This is especially important due to the prolonged time that the individual wears a brace. Stretching exercises also maintain the reduction of spasm.

Strengthening the muscles is the third objective of rehabilitation to prevent future injury. Individuals may also perform conditioning exercises such as walking or swimming to increase endurance and strength as tolerated.

Therapy also addresses correct posture, proper body mechanics, and ergonomics. Individuals learn strategies to sit and stand in positions of ease, to reach and lift in a way that protects the back and neck, and to pace activities.

Source: Medical Disability Advisor



Complications

A common complication of the laminectomy and laminotomy procedures is some degree of neck or back pain. Relief may be obtained with painkilling injections or medication.

Infection of the wound is uncommon and can usually be treated with antibiotics. Surgery is sometimes required to treat severe infections with abscess formation by allowing them to drain. Antibiotics are routinely given pre-operatively to help prevent postsurgical infection. Other complications with any type of surgery include uncontrolled bleeding that requires blood transfusions, injury to blood vessels, or injury to neighboring structures.

Dural tear and cerebrospinal fluid leak may occur with surgery, particularly in cases where there has been a previous surgery. If the nerve covering (dura) is torn, leakage of spinal fluid may lead to headache or infection. A dural tear may be managed intraoperatively with repair of the tear or may require management postoperatively with drainage.

Neurologic injury may also occur if the spinal cord and spinal roots (exposed during the surgery) are damaged. Fortunately, these complications are rare. This kind of damage in the thoracic and cervical region may cause numbness, paralysis of the upper and/or lower extremities based on the location, difficulties walking or moving around (ambulation), or impaired bowel/bladder function.

As with any surgery requiring general anesthesia, complications of anesthesia may include allergic reaction, irregular heart rate (cardiac arrhythmia), a drop in blood pressure (hypotension), muscular rigidity, and severe and sometimes fatal temperature elevation (malignant hyperthermia). Because the individual lies face down during the procedure, when the bone is cut there is an increased risk of air embolism, in which air can enter a vessel and travel to a smaller blood vessel. This can cause blockage and stroke or loss of blood flow to the organ supplied by the affected vessel.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Lifting, standing, bending, and walking while at work may be restricted during the recovery period. For about 3 weeks after discharge, the individual may be advised to limit sitting to no longer than 15 to 30 minutes without getting up to move or switch activities.

The individual should be discouraged from participating in work activities that cause unusual movement and stress to the spine, such as excessive bending, lifting, stooping, unassisted carrying, and overhead work, depending on the level of the procedure. When the individual does return to physical activities, they should be performed with careful attention to proper body mechanics. Use of a lumbar support or belt may be helpful for repeated lifting.

Source: Medical Disability Advisor



References

Cited

Choy, D. S. "Familial Incidence of Intervertebral Disc Herniation: An Hypothesis Suggesting that Laminectomy and Discectomy May be Counterproductive." Journal of Clinical Laser Medicine & Surgery 18 1 (2000): 29-32. National Center for Biotechnology Information. 18 Feb. 2000. National Library of Medicine. 26 Jan. 2009 <PMID: 11189109>.

Source: Medical Disability Advisor






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