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.

Spinal Cord Stimulation


Related Terms

  • Dorsal Column Stimulation

Specialists

  • Anesthesiologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon

Factors Influencing Duration

Length of disability may be influenced by the underlying condition for which the procedure was done, the effectiveness of the pain relief provided by the procedure, or the presence of complications. Use of percutaneous electrodes have a shorter disability duration than plate-type electrodes, which require open surgery.

Medical Codes

ICD-9-CM:
03.39 - Other Diagnostic Procedures on Spinal Canal and Spinal Cord Structures

Overview

Spinal cord stimulation (SCS), also known as dorsal column stimulation, is a procedure for relieving chronic, severe pain through electrical stimulation of the spinal cord. It is accomplished by implanting an electronic stimulator near the spine to interrupt pain signals to the brain.

The basic SCS unit consists of one or more electrodes implanted in the space just outside the spinal cord (epidural) and a pulse generator implanted in a pocket underneath the skin (subcutaneous). There are two types of electrodes: percutaneous and plate-type. Percutaneous electrodes are inserted through a needle as an outpatient procedure. Plate electrodes require open surgery for placement but have a greater inherent stability and, once implanted, are less likely to dislodge.

There are also two types of pulse generator/receiver systems: a totally implantable system or a radio frequency system. The totally implantable pulse generator contains a lithium battery as the power source. It can be turned on and off by the individual with a small magnet, but some of the regulation requires outside telemetry. Lithium batteries last from 3 to 4.5 years. The radio frequency system consists of a passive receiver implanted under the skin and a transmitter, which is worn outside the body, powered by alkaline batteries. The individual has full access to all the features available, including changing the electrode combinations. Both systems have advantages and disadvantages. The decision as to which system is more appropriate should be made on an individual basis.

The most common conditions treated with SCS are reflex sympathetic dystrophy (experimental); failed back surgery syndrome (a controversial term); persistent pain of radicular origin that has not been relieved by surgical intervention and for which diagnostic studies fail to reveal a specific organic cause besides nerve damage; phantom limb pain, in which the individual has the sensation of pain in a limb that has been removed by amputation; ischemic pain of vascular origin, in which blood supply to the tissues is decreased; adhesive arachnoiditis (when associated with nervous system); and peripheral neuropathy.

Source: Medical Disability Advisor



Reason for Procedure

SCS is used to treat individuals with chronic pain whose conditions have failed to respond to other, less invasive treatments. More recent uses include treatment of pain caused by angina pectoris, cancer, multiple sclerosis, or herpes zoster (shingles) and various types of chronic pain caused by nerve (or spinal cord) damage as a result of trauma.

Source: Medical Disability Advisor



How Procedure is Performed

The individual must undergo a selection process to qualify for this treatment. Once health care professionals have determined the underlying cause of the pain, they must ascertain that conservative therapies, such as medication or epidural blocks, have failed and that further surgery would not be beneficial. They must then ensure that the individual has no untreated drug addictions and is not suffering from any psychological disorders (such as depression or personality disorders) that might interfere with pain management.

The next step is a trial screening, in which the effectiveness of SCS is tested in a reversible process that uses a temporary power source. This device mimics the permanently implanted device. Under local anesthesia, a lead containing two to eight electrodes is placed in the epidural space, near the spinal cord, through an incision or hollow needle placed in the skin. When the electrodes are in place, they are attached to the rest of the components in the system, and a small electric current is conducted through the electrode. The exact placement depends on where the individual experiences pain. The physician determines the exact patterns of stimulation by talking with the individual during implantation about the effects on the individual's pain. The electrode is taped in place to the skin of the back. Following the trial procedure, the individual is instructed on the use of the stimulator system and on how to care for the incision. The individual is instructed to keep a "diary" of pain and daily activities. The trial period may last anywhere from 1 day to several weeks and will help determine whether SCS will control the individual's pain and whether the individual is comfortable with the sensation. If the trial period is successful (the individual experiences at least a 50% decrease in pain with no major complications), the temporary stimulator is removed, and a permanent implantation will be performed.

The implantation of the permanent SCS system resembles that for the trial procedure. To make the implant permanent, a small incision is made in the back, and the electrode is attached to the covering of the deep muscles in the back (fascia). Because percutaneously inserted electrodes can be dislodged by routine daily activities, better anchoring of the electrodes is often recommended and accomplished through a small laminectomy and suturing of the electrode plate to the dura. This procedure is performed under local anesthesia. A battery pack (generator) or receiver is also implanted through an incision into the fatty layer of either the lower abdomen or the buttocks. The individual usually remains in the hospital for 1 day for observation.

Source: Medical Disability Advisor



Prognosis

According to a study done from 1991 to 1998 at an Alabama pain clinic, after undergoing this surgery, 65.7% of people reported half the amount of pain that they used to when engaged in their daily routine and said they would not hesitate to have the surgery again to have the identical outcome. Almost 79% found the surgery cost-effective, meaning they reported a 50% decrease in the number of visits to emergency rooms and doctor and surgeon offices (Willis).

Source: Medical Disability Advisor



Complications

The individual may experience some discomfort or swelling at the incision sites, which may last for several days. Some individuals also experience pain over the area where the receiver is implanted for several weeks. Complications from the surgery are uncommon but include infection, bleeding, headaches, seizures, and spinal cord injury.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Immediately after surgery, the individual must avoid lifting, stretching, bending, and twisting movements. The individual must permanently avoid any activities that may cause movements in the leads. The SCS device may not be used while operating a motor vehicle or other heavy equipment; therefore, the individual's need for pain relief must be balanced against such work requirements.

Source: Medical Disability Advisor



References

Cited

Willis, K. Dean. "A Simple Approach to Outcomes Assessment of the Therapeutic and Cost Benefit Success Rates for Spinal Cord Stimulation therapy." Anesthesiology Clinics Of North America 21 4 (2003): 817-823. MD Consult. Elsevier, Inc. 18 Oct. 2004 <http://home.mdconsult.com/das/journal/view/41697674-2/N/14208169?sid=307949699&source=MI>.

Source: Medical Disability Advisor






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