|Conservative, nonsurgical treatment using analgesics, spinal (epidural) or oral steroids, physical therapy (aerobic conditioning, muscle strengthening, flexibility enhancement, and optimization of body mechanics), and bracing may provide symptom relief in milder cases without neurological symptoms. Cervical traction may provide relief of radicular pain stemming from nerve root compression in the cervical spine but will not relieve the pain of soft tissue injury. A soft cervical collar may provide short-term relief of soft-tissue injury; for radiculopathy caused by foraminal stenosis, the collar is placed in a manner that allows neck flexion and extension and to open the intervertebral foramina. Only decompressive surgery can actually enlarge the spinal canal of the lumbar and cervical spine. If signs and symptoms of myelopathy, segmental instability, or cauda equina syndrome (nerve compression affecting bladder and bowel function) are present, emergency surgical decompression of the spinal cord or nerve roots is indicated. Surgery is also indicated for individuals with moderate to severe symptoms that are not relieved by conservative measures and time. |
The goals of surgery are to reduce pain, decompress affected nerves, provide more room for the spinal cord, and restore spinal stability. The method of surgical decompression employed depends on the location, cause, type, and severity of spinal stenosis; the age and overall condition of the individual; and the preference of the surgeon. If a sufficient portion of the joint is removed or the individual has advanced degenerative disease, then it may also become necessary to perform arthrodesis (with or without stabilizing internal fixation) to stabilize the spine.
Lumbar decompressive surgery, which may consist of one or more procedures, is performed through an incision in the back. Most frequently, the lamina of a vertebra are removed (laminectomy), often at multiple levels. Other surgical options include removal of bone from around a nerve root (foraminotomy), removal of an intervertebral disc (discectomy), and/or fusion of two or more vertebrae (arthrodesis).
Cervical spine surgery may consist of foraminotomy to open the foramen and decompress the affected nerve; laminotomy to create a hole in the lamina and reduce pressure on the spinal cord; laminectomy, which removes part or all of the lamina to reduce pressure on the cord; or laminoplasty, which reshapes the lamina surgically, creating more room for the spinal cord. Cervical procedures can be performed from the front (anterior) of the spine or at the back of the neck (posterior). Cervical stenosis is frequently the result of anterior compression due to osteophyte formation, requiring the more difficult anterior surgical approach, which also involves higher risk and may require fusion. Fusion is not indicated for patients with poor health status or reduced bone density.
Source: Medical Disability Advisor
|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|
Neck and Upper 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