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.

Myelopathy


Related Terms

  • Spinal Cord Dysfunction
  • Spinal Cord Injury

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on the specific diagnosis, the location and completeness of the lesion, the severity of the lesion, the severity of the symptoms, whether it is acute or chronic, and the severity of functional loss. The disability could be transient or permanent, and would depend on the cause of the myelopathy and any treatment options.
Duration of disability depends on the cause, type, and extent of loss of movement and sensation, and the individual's response to treatment. A more specific diagnosis is required to determine disability duration.

Medical Codes

ICD-9-CM:
336.1 - Vascular Myelopathies
336.8 - Myelopathy, Other, Drug-Induced, Radiation-induced
336.9 - Myelopathy, Unspecified

Overview

Myelopathy is an inclusive term referring to any disease of the spinal canal. The following are examples of myelopathy: carcinomatous myelopathy (spinal cord degeneration associated with cancer); compressive myelopathy (spinal cord changes from the pressure of hematomas or masses); and radiation myelopathy (spinal cord destruction from radiation sources such as x-ray therapy). When the spinal cord destruction is caused as a complication of disease, the specific myelopathy signifies that origin; for example, diabetic myelopathy.

Myelopathy may be caused by spinal cord trauma (fracture or dislocation of the vertebrae), herniated disc (intervertebral disc disorder with myelopathy), osteoarthritis of the spine (spondylosis), or a space-occupying lesion such as a tumor. It may also be the clinical presentation of an infectious or inflammatory process, as well as a vascular occlusion within the spinal cord (spinal cord stroke). A syndrome that results from compression of one side of the spinal cord, above the tenth thoracic vertebrae and is characterized by spastic paralysis on the body's injured side and loss of postural sense and the senses of pain and heat on the other side of the body (Brown-Séquard's syndrome) may also be a type of myelopathy. Additional causes include viral infections, immune reactions, or insufficient blood flow through the vessels in the spinal cord. It may occur as a complication of loss of nerve sheath tissue (demyelination) or as a complication of reactions to smallpox, measles, or chickenpox vaccinations.

Incidence and Prevalence: There is no specific information on incidence of myelopathy obtainable. However, information on some common causes of myelopathy is available. There are approximately 12,000 to 15,000 spinal cord injuries in the US each year (Campellone).

A variety of tumors may cause spinal cord compression. Primary spinal cord tumors are relatively rare in the adult with an incidence of 0.5 to 2.5 per 100,000 in the US (Huff). It is estimated that 5% to 10% of individuals with cancer will have tumor growth in the epidural space, causing more than 25,000 cases of myelopathy per year; of these, 60% will occur in the thoracic spine, and 30% in the lumbosacral spine (Schiff).

Prevalence of cervical spondylotic myelopathy is 50% in men and 33% in women by 60 years of age (Baron).

Source: Medical Disability Advisor



Causation and Known Risk Factors

In general, a disease or injury resulting in a myelopathy can begin at any time of life and affects males and females in equal numbers. The level of the spinal cord lesion determines the extent of functional loss.

The highest incidence of primary spinal cord tumors is occurs in individuals between 30 to 50 years of age (Huff).

Spinal cord injuries are more common in males between 15 and 35 years of age (Campellone).

Cervical spondylotic myelopathy is the most common spinal cord disorder in individuals aged 55 and older in the US (Young). Individuals who sustain repeated trauma such as carrying heavy loads or participating in gymnastics may have an increased risk for cervical spondylotic myelopathy.

Individuals with underlying vascular disease may be more at risk for an unusual vascular occlusion to arteries in the spinal cord. Those with a prior history of multiple sclerosis may be more likely to develop myelopathic symptoms.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of myelopathy vary depending on the cause, the severity of the condition, and whether the problem causing myelopathy is acute or chronic. In the case of a spinal cord tumor, compression, or trauma there may be pain (that may also radiate down the arms or legs), loss of sensation or movement, and/or contractures on one, both, or alternate sides of the body. If the cause is osteoarthritis, there may be complaints of pain and tenderness, decreased spinal range of motion, weakness, and possible spinal deformity. Myelopathy may also present with loss or alteration of bowel or bladder function, or loss of sensation or numbness in the genital areas. Infections causing myelopathy may produce fever, redness, swelling, and increased tenderness. If the individual suffers from Brown-Séquard's syndrome, there may be spastic paralysis on the body's injured side and loss of postural sense and the senses of pain and heat on the other side of the body.

Physical exam: A standard neurologic exam may reveal disease involving the spinal nerve (cervical radiculopathy) or leg spasticity. Clonus may be an indication of an upper motor neuron disorder, localized to the spinal cord. The individual will be tested for reflexes (which may be overactive or reduced depending on the cause) and loss of or alteration in sensation. Sensory testing along the entire length of the body, from the legs to the face may be necessary to determine if a level of anesthesia exists. Also, abdominal reflexes may be helpful to determine what level such a lesion exists. There may be paralysis and/or diminished sensation over various parts of the body. Voluntary movement may be diminished. Assessment of rectal tone is important in an examination to rule out myelopathy.

Tests: Diagnostic testing depends on the history and physical examination findings. X-rays, bone scan, computerized analysis of multiple x-rays (CT) or a magnetic field study (MRI) of the spinal cord may detect lesions in or near the spinal cord. Laboratory tests may be indicated to rule out other causes (such as vitamin B12 deficiency or heavy metal poisoning). An elevated white blood cell count suggests infection (meningitis or osteomyelitis of the spine). An elevated erythrocyte sedimentation rate of the blood (ESR) may be a sign of inflammation, infection, or tumor. A lumbar puncture may be done to obtain cerebrospinal fluid (CSF) for laboratory tests if meningitis or multiple sclerosis is suspected. Other diagnostic tests may include biopsies of bone or soft tissue, and culture of blood or cerebrospinal fluid.

Source: Medical Disability Advisor



Treatment

Treatment depends on the cause of myelopathy. For fractured or dislocated vertebrae, pain medications (analgesics), traction, immobilization for several weeks, and rehabilitation therapy (physical, occupational, and vocational) may be needed. Surgery to correct spinal deformity may include removal of part of the vertebra(e) and/or fusion of the fractured vertebrae. Analgesics, medications to reduce inflammation (steroids), and possibly physical therapy may be used to treat arthritic problems. Medications for multiple sclerosis may be helpful, including newer medications or steroids. Infections require medications to eliminate the infection (antibiotics), to reduce fever (antipyretics), and possibly anti-inflammatory drugs (steroids) to reduce existing inflammation. Myelopathy caused by compression of the spinal cord may require surgery to remove a tumor or a herniated disc (laminectomy).

Source: Medical Disability Advisor



Prognosis

Outcome depends on the cause of the myelopathy and any permanent neurological damage. Traction and immobilization of the spinal column may lead to complete recovery if no residual damage has been done to the spinal cord. Complete recovery is also possible in cases of infection. Chronic conditions such as arthritis and osteoporosis cause variable outcomes ranging from no further progression of problems, or continual progression resulting in deformed spinal column and decreased mobility, to the point of needing assistive devices such as a cane or a wheelchair. Spinal cord injury or compression may result in permanent residual damage, including loss of sensation over various parts of the body as well as a loss of voluntary movement in the extremities. Recovery after a tumor removal depends on any residual damage if the tumor is cancerous, and if the cancer has spread. Recovery after removal of a herniated disc (discectomy) is often excellent as long as no damage is done to the spinal cord during surgery or as a result of compression.

Source: Medical Disability Advisor



Complications

Complications as a result of myelopathy may be addiction to pain medication, permanent loss of sensation and/or voluntary movement, spinal deformities, and bladder hyperactivity with urgency and frequency.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations would most likely be required if there is permanent damage to the spinal cord following trauma, surgery, or due to lengthy compression of the cord. If mobility is lost, the work environment needs to be wheelchair accessible. If loss of movement affects upper extremities, equipment such as telephones and computers may need to be adapted. Vocational counseling may be necessary.

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:

  • Has individual had spinal cord trauma, herniated disc, osteoarthritis of the spine, or a tumor? Were there any viral infections, immune reactions, or insufficient blood flow through the blood vessels in the spinal cord?
  • Does individual have any demyelination?
  • Does pain radiate to any extremities? Is there pain and tenderness over the area? Does pain occur with movement, weakness, or possible spinal deformity?
  • On exam, was radiculopathy or spasticity noted? Were reflexes and sensation normal or abnormal? Was any paralysis noted?
  • Has individual had x-rays, bone scan, CT, or MRI of the spinal cord? Were laboratory tests done? Lumbar puncture? Were biopsies of bone or soft tissue performed?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Does individual have a fractured or dislocated vertebrae? Is it being treated with analgesics, traction, and immobilization?
  • Does individual have an arthritic problem? Is it being treated with analgesics or steroids?
  • Is there an infection? Is it being treated with antibiotics?
  • Does individual have compression of the spinal cord? Was surgery necessary?

Regarding prognosis:

  • Is individual active in rehabilitation? Is a home exercise program in place?
  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Has individual become addicted to pain medication? Are there any other complications such as loss of sensation or voluntary movements? Spinal deformities?

Source: Medical Disability Advisor



References

Cited

Baron, Eli M., and William F. Young. "Cervical Spondylosis: Diagnosis and Management." eMedicine. Eds. William J. Nowack, et al. 7 Jan. 2005. Medscape. 20 Oct. 2004 <http://emedicine.com/neuro/topic564.htm>.

Campellone, Joseph V. "Spinal Cord Trauma." MedlinePlus. National Library of Medicine. 20 Oct. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/001066.htm>.

Huff, Stephen J. "Neoplasms, Spinal Cord." eMedicine. Eds. Edmond Hooker, et al. 1 May. 2001. Medscape. 20 Oct. 2004 <http://emedicine.com/emerg/topic337.htm>.

Schiff, David. "Spinal Cord Compression." Neurologic Clinics 21 1 (2003): MD Consult. Elsevier, Inc. 20 Oct. 2004 <http://home.mdconsult.com/das/journal/view/41764989-2/N/12615523?sid=291422405&source=MI>.

Source: Medical Disability Advisor






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