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 Stenosis


Related Terms

  • Cervical Stenosis
  • Lumbar Stenosis
  • Narrowing of Spinal Canal

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

The severity of pain, the severity of the neurologic deficit, comorbid vascular disease, the individual's age and overall health, and the type and success of treatment will influence the length of disability. Once severe spinal stenosis with neurologic deficit becomes evident, the individual is rarely capable of heavy or very heavy work. Following lumbar spinal stenosis decompression surgery, heavy and very heavy work are usually no longer appropriate.

Medical Codes

ICD-9-CM:
723.0 - Spinal Stenosis In Cervical Region
724.00 - Spinal Stenosis, Other than Cervical, Unspecified Region
724.02 - Spinal Stenosis, Other than Cervical, Lumbar Region, without neurogenic claudication; Lumbar region NOS
724.09 - Spinal Stenosis, Other than Cervical, Other
724.9 - Other Unspecified Back Disorders; Ankylosis of Spine NOS; Compression of Spinal Nerve Root NEC; Spinal Disorder NOS

Treatment

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

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






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