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.

Pott's Disease


Related Terms

  • Spondylodiscitis
  • Tuberculosis of the Spine
  • Tuberculous Spondylitis

Differential Diagnosis

Specialists

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

Comorbid Conditions

Factors Influencing Duration

The length of disability may be influenced by the severity of the symptoms; the extent of the infection; whether treatment is prompt and appropriate; whether surgery is performed; the extent of lung involvement, if any; the individual's response to treatment; the age of the individual; and the presence of a concurrent immune deficiency condition.

Medical Codes

ICD-9-CM:
015.00 - Tuberculosis of Vertebral Column; Potts Disease; Unspecified
015.01 - Tuberculosis of Vertebral Column; Potts Disease; Bacterial or Histological Examination Not Done
015.02 - Tuberculosis of Vertebral Column; Potts Disease; Bacterial or Histological Examination Unknown
015.03 - Tuberculosis of Vertebral Column; Potts Disease; Tubercle Bacilli Found (in Sputum) by Microscopy
015.04 - Tuberculosis of Vertebral Column; Potts Disease; Tubercle Bacilli Found by Bacterial Culture
015.05 - Tuberculosis of Vertebral Column; Potts Disease; Tuberculosis Confirmed Histologically
015.06 - Tuberculosis of Vertebral Column; Potts Disease; Tuberculosis Confirmed by Other Methods [Inoculation of Animals]

Overview

Pott's disease is a form of tuberculosis (TB) that affects the thoracic or lumbar spine. Caused by the bacteria Mycobacterium tuberculosis, which is transmitted by airborne droplets, the infection may occur in conjunction with tuberculosis of the lung or years later as a reactivation of the disease. Progressive destruction of the spine can cause an abnormal curvature of the spine. If untreated, the infection can lead to paraplegia.

Recently, scientists and doctors have noticed an increase in the number of cases of tuberculosis, even in countries where the disease had become quite rare. The increased number of cases of active tuberculosis infection is due in part to the number of individuals with compromised immune systems (such as HIV infection); tuberculosis has also increased among ethnic minorities. Exposure occurs by sharing common airspace with infectious persons.

Incidence and Prevalence: Pott's disease accounts for 40% to 50% of cases of musculoskeletal TB in the US; the disorder accounts for roughly 1% to 2% of patients with TB worldwide (Hidalgo). People from other countries are also more likely to have it.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Poverty is a risk factor for tuberculosis; poor and minority communities that more intensely share living space are less likely to take advantage of available tuberculosis vaccine. Studies done in New York and Los Angeles have revealed that TB of the muscles and skeleton is more prevalent in black, Asian, and Hispanic Americans. Adults are more likely to be affected, and men are 1.5 to 2.0 times more likely than women to contract the infection (Hidalgo).

Source: Medical Disability Advisor



Diagnosis

History: Mycobacterium tuberculosis is a slow-growing organism. The individual's history may include a prior diagnosis of tuberculosis, living in an area of widespread tuberculosis infection, or exposure to a person with active tuberculosis. Symptoms in the spinal region may include swelling, back pain, or stiffness that is usually worse at night.

Physical exam: The exam may show localized tenderness over the spine; pain may precede x-ray changes by weeks to months. As the disease progresses, abnormal curvature in the spine may develop. Deformities may include a humpback (kyphoscoliosis) or a side-to-side curvature (scoliosis). Abscesses may be present in adjacent tissues. Collapse of the spinal vertebrae may cause spinal cord and nerve compression. An individual's neurological exam may be positive for paralysis of the extremities and cranial nerve palsies.

Tests: The tests may include a skin reactivity test for M. tuberculosis or detection of the organism from joint fluid, pus, or tissue samples. Secondary to infection, the individual could have a very high erythrocyte sedimentation rate (ESR). A biopsy may also be taken of the bony lesion or a regional lymph node. Plain x-ray may show degeneration of vertebrae or narrowing of the disc spaces. A CT scan can demonstrate the degree of soft tissue infection surrounding the spinal cord. The extent of nerve damage and infection can be seen on MRI. A chest x-ray or sputum smear and culture may show evidence of lung infection with M. tuberculosis. A protein-purified derivative (PPD) or tuberculin skin test can be placed on the arm; it becomes raised if the person has been exposed to TB.

Source: Medical Disability Advisor



Treatment

Pott's disease is treated with multiple antibiotics. Because of the recent increase in antibiotic-resistant organisms, the recommended treatment includes the use of a four-drug regimen. Treatment must be maintained for at least 6 to 9 months, and some doctors advise individuals to take medication for as long as 9 to 12 months. Immunodeficient individuals may require lifelong drug therapy to keep the infection from recurring. In the past, immobilizing the patient with a cast or a splint may have been recommended, but now external bracing only is the intervention of choice, allowing the individual to participate in rehabilitation and self care. Surgery (spinal fusion, rod placement) may ultimately be needed to relive spinal cord pressure, correct abnormal curvature of the spine, or resolve spinal instability secondary to loss of bone mass. Although brief bed rest may be indicated, rehabilitation to promote independent transfers and ambulation should be attempted as soon as tolerated.

Source: Medical Disability Advisor



Prognosis

Prognosis is variable. Some individuals will recover completely, particularly if the infection is treated promptly and aggressively. Advanced disease may leave the individual with long-term disability even after the bacterial infection has been cured. Those requiring long-term suppressive therapy may develop recurrences if drug therapy is not maintained. Spinal fusion may be effective in relieving discomfort, depending on the severity of symptoms. Surgery will not, however, treat the underlying disease. In the past, prior to the discovery of drugs for TB that helped treat the disease, 20% of patients died and 30% had recurrences of their symptoms (Hidalgo).

Source: Medical Disability Advisor



Rehabilitation

Many individuals with Pott's disease present with spinal instability, vertebral collapse, and progressive neurological signs that may ultimately require spinal surgery (spinal fusion). Rehabilitation for individuals following spinal fusion will depend on the type of instrumentation used, the preoperative status of the individual, and the number of spinal segments fused. Care must be taken to protect the fusion site until diagnostic tests reveal that fusion has fully occurred. The goals of rehabilitation are for the individual to achieve independent mobility and self care with activities of daily living (ADLs).

Initially, physical therapists instruct individuals to isometrically contract the muscles, progressing to passive range of motion and gentle stretching of the extremities while maintaining spinal stability. Individuals begin active assisted range of motion and then active movement as recommended by the surgeon. Those with paraplegia may require inpatient physical and occupational therapy to learn safe bed mobility, transfer techniques, ambulation, bowel and bladder management, self care with ADLs, and use of adaptive equipment or assistive devices as needed.

A short course of outpatient rehabilitation may be necessary to focus on strength and endurance progression, independent ambulation, instruction in body mechanics, and functional mobility. An ergonomic assessment of the workplace may be indicated to facilitate return to work.

Source: Medical Disability Advisor



Complications

Antibiotic-resistant strains of bacteria pose complications for the treatment of spinal tuberculosis. Without effective therapy, bone and joint destruction may occur. Abscesses may spread into adjacent soft tissues, forming sinuses. Collapse of spinal vertebrae may cause spinal cord and nerve compression.

Paraplegia, or paralysis of the lower body, is the most serious complication of spinal tuberculosis. Immunodeficiency contributes to a more rapid progression of the infection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals must be restricted from work for 10 to 14 days when respiratory tuberculosis is concurrently present. Accommodations may be required for recovery from surgery or as a result of permanent locomotor disability. It may be necessary to reassign the individual to a more sedentary position. Heavy lifting, prolonged bending, and strenuous exercise will be restricted. If paralysis occurs, accommodations such as wheelchair access and specially equipped bathroom facilities 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:

  • How old is individual? Does individual live at the poverty level?
  • Is individual's immune system compromised?
  • Has individual had tuberculosis in the past? Currently?
  • Does individual complain of swelling, back pain, or stiffness that is worse at night? Are any other joints involved?
  • On exam, was localized tenderness over the spine present? Does individual have kyphoscoliosis or scoliosis? Are there any abscesses present in adjacent tissues?
  • Does individual have spinal cord and nerve compression?
  • Has individual had a skin test for TB? Have joint fluid, pus, or tissue samples been tested for the presence of M. tuberculosis? Have a sputum smear and culture been performed?
  • Has individual had a plain x-ray of the affected area? CT?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with the four-drug regimen?
  • Is culture confirmation with antibiotic sensitivities available?
  • Was surgery necessary to correct spinal deformities?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications occurred, such as antibiotic-resistant strains of bacteria, bone and joint destruction, abscesses, or collapse of spinal vertebrae with spinal cord and nerve compression? Does individual have paraplegia or paralysis of the lower body?

Source: Medical Disability Advisor



References

Cited

Hidalgo, Jose A. "Pott Disease (Tuberculous Spondylitis)." eMedicine. Eds. Thomas Herchline, et al. 17 Nov. 2004. Medscape. 1 Nov. 2004 <http://emedicine.com/med/topic1902.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.