Does Spinal Fusion Cause Permanent Disability from Work?
Understanding the Limitations and Medical Work Restrictions Your Surgeon May Prescribe After Spinal Fusion
Surgeons perform more than 350,000 spinal fusion procedures yearly. And the number of cervical and lumbar fusion surgeries continues to grow.
These operations are expensive, often costing $50,000 or more. Indeed, we regularly see six-figure charges for spinal fusions in workers compensation and car accident cases.
But this is not the only cost you may face if you have a neck or back injury that herniates a disc, aggravates or exacerbates preexisting degenerative disc disease, such as spinal stenosis, and requires a single-level or multi-level fusion.
You may also have permanent restrictions after spinal fusion. And these limitations from spinal cord injury may cause long-lasting disability from work.
This article examines the likelihood of receiving permanent restrictions after spinal fusion and the return-to-work issues you may have after one of these operations to treat a back injury or degenerative disc disease.
The extent of disability after a fusion determines the settlement value of your workers comp case or car accident claim and the strength of your Social Security disability claim.
Keep reading for more information about your potential limitations after spinal fusion.
And call us if you want to speak with one of Virginia’s best personal injury and tort lawyers: 804-251-1620 or 757-810-5614.
How Long Does It Take to Recover From Spinal Fusion Surgery?
The healing and recovery process differs for everyone. But spinal fusion surgery often requires an extended healing period, and the data and our experience provide a general recovery timeline.
First, you will likely spend a few days in the hospital after the fusion procedure. The exact length depends on whether you have surgical complications and your support system at home. For example, you will go home sooner if someone is available to drive you, pick up your prescription medications, or help with daily living activities.
After discharge from the hospital, your orthopedic surgeon will likely disable you from all work for one to three months. The goal during this period is to let you rest so the vertebrae fuse.
At some point, your doctor will prescribe physical therapy and gentle exercises. You may, however, continue to be disabled from all forms of work so you are not in a situation where you have to drive, bend, twist, or lift.
Once you approach the six-month mark post-fusion, your doctor may release you to light-duty work if they have not already. Usually the vertebrae have fused by this time (if the surgery is successful). Common light-duty restrictions from months six to nine include sedentary work (seated work primarily), limited driving (no more than 30 minutes at a time), no twisting or bending, and lifting no more than 20 pounds occasionally.
The fused bone continues to solidify from eight to 18 months after the fusion. At this point, your doctor may declare that you have reached maximum medical improvement (MMI) and refer you for a functional capacity evaluation (FCE) to determine your level of permanent impairment and life-long restrictions.
How Do Physicians Decide Return-to-Work Issues After Spinal Fusion?
In our experience, many doctors would rather avoid assessing work restrictions and limitations because they need more training in this area, and their opinion may create conflict with the patient. This preference explains why FCEs are so prevalent in workers compensation cases.
But for those physicians that wade into determining permanent restrictions, “[t]he American Medical Association [AMA} encourages physicians everywhere to advise patients to return to work at the earliest date compatible with health and safety and recognizes that physicians can, through their care, facilitate patients’ return to work.”
We agree with and understand the desire to return patients to work. Indeed, most (if not all) of our clients want to return to work and put the industrial accident or occupational illness behind them. And earning a living can improve mental health.
But we fear that blind adherence to this principle may result in physicians releasing spinal fusion patients back to full duty too soon, leading to re-injury and more significant disability from work.
The AMA instructs physicians to consider three factors when assessing a patient’s ability to work: risk, capacity, and tolerance.
- Risk – the probability of harming yourself or others if you return to work.
- Capacity -your measurable physical abilities (strength, flexibility, aerobic capacity, etc.) compared to your pre-injury job’s essential physical demands.
- Tolerance – your ability to sustain work at a specific level despite the pain
From there, your doctor will say what limitations (activities you cannot do because of the fusion) and restrictions (things you can do but should not because of the injury) you have.
Perceived tolerance for work causes the most disputes between insurers, employers, injured workers, and doctors. And your physician’s ability to stay strong and provide permanent restrictions after spinal fusion that you are comfortable with, as opposed to the nurse case manager or claims adjuster, often determines your case’s trajectory.
Factors Affecting Permanent Restrictions After Spinal Fusion Operations
Several variables affect your permanent restrictions after spinal fusion, if any.
These factors include the following:
- Age: Older patients may have more difficulty recovering from spinal fusion and returning to their preoperation abilities. For example, the Social Security Administration’s (SSA’s) “Grid Rules” recognize this concept and make it easier for persons over age 50 to qualify for SSDI or SSI.
- Complications: Like most surgeries, you risk suffering complications from spinal fusion. For example, this procedure may result in excessive blood loss, infection, nerve damage, adjacent segment disease (erosion of the discs above or below the fused levels), hardware failure, and continued pain. Indeed, some of you will need additional spinal surgeries, including a revision or extension of the fusion.
- Deconditioning: Many injured workers have missed weeks or months of work before undergoing spinal fusion. This recovery period often results in deconditioning, making it more challenging to return to baseline after the procedure. And muscle fatigue is a common problem for fusion patients that return to light-duty work.
- Fused Level: A low back fusion will cause different mobility limitations than a cervical spine fusion.
- Number of Vertebrae Fused: A single-level fusion typically results in fewer permanent restrictions than a multi-level fusion.
- Overall Health: Your employer in a workers comp case or the defendant in an automobile accident claim must take you as they find you. If you were in poor health before the accident that caused or contributed to the need for the spinal fusion, you would likely take longer to heal and have more permanent restrictions than a person in good shape before the surgery.
- Psychological Impact: A work injury that is significant enough to cause the need for spinal fusion and permanent work restrictions may cause anxiety, depression, or post-traumatic stress disorder (PTSD) that hinders recovery and worsens pain.
Common Permanent Work Restrictions Due to Spinal Fusion
Considering the above variables, this section looks at common work restrictions that spinal fusion patients receive in workers comp and motor vehicle collision cases.
- Carrying, Lifting, Pushing, and Pulling: Your doctor will likely prescribe permanent lifting restrictions after fusion to reduce the risk of re-herniation or more damage. Further, your deconditioning and muscle atrophy may limit how much weight you can move.
- Environment: You may have an altered gait (for example, a limp) after lumbar fusion that affects your balance. Your doctor, therefore, may limit your ability to work on uneven surfaces or at heights. In addition, you may be unable to climb steps or ladders.
- Foot Controls: Continued numbness, tingling, and decreased sensation in your feet after lumbar fusion may lead to restrictions in using machinery with foot pedals.
- Hand Use: You may have continued numbness and tingling in your hands after a cervical fusion that affects your ability to reach in front of your body or overhead or use your hands and fingers to grasp, turn, or manipulate objects.
- Headaches: Headaches and migraines may occur (or continue) after cervical fusion. These headaches can affect your ability to get along with others, follow directions, or maintain attendance.
- Limited or No Driving: Chronic pain may continue after spinal fusion, causing insomnia or the need to take medications that cause drowsiness. Your doctor may prescribe permanent restrictions after fusion that limit the distance you can drive without taking a break or prohibit you from operating heavy machinery, such as tractor-trailers or forklifts.
- Limited Range of Motion Affecting Postural Activities: Fusion causes a loss in spinal flexibility and reduces your range of motion. Therefore, your permanent restrictions may include little or no twisting, stooping (bending), crouching, squatting, or head rotation. And diminished head and neck rotation affects your ability to perform jobs requiring a phone or computer.
- Need to Change Positions: After fusion, you may experience pain, numbness, or tingling if you stay in one position (standing, sitting, walking) for too long.
- Proximity to a Restroom: You may have ongoing neurological problems, such as bladder or bowel control loss, after spinal fusion (depending on the extent of your injury or condition). And these problems may limit you to working inside and near a bathroom.
- Sitting: Staying seated for prolonged periods after lumbar or cervical fusion may be challenging. Your physician, therefore, may reduce the number of hours you can sit at work.
- Standing and Walking: Your doctor may prescribe an assistive device (cane, crutches, wheelchair) and limit the hours or distance you can walk independently without stopping or totally during the work day.
- Unscheduled Breaks: Unscheduled breaks where you lie down or sit in a quiet room may keep your post-fusion pain under control during the work day. But too many breaks may result in the employer finding you off-task too much to maintain employment.
Are You Safe to Return to Work After Spinal Fusion?
Employers, insurers, and third-party claim administrators such as Sedgwick, Gallagher Basset, and ESIS know the data shows the percentage of workers who successfully return to the labor force significantly drops after six months of absence/disability from work. And that employees out of work for more than one year are more likely to remain unemployed than they are to return to work.
Statistics like these are why insurance defense attorneys, claims adjusters, and nurse case managers often push doctors to push patients back to work before they are physically or mentally ready.
These efforts often succeed because many doctors are uncomfortable with return-to-work issues. Indeed, your physician may have yet to receive any training on assessing work restrictions and limitations.
But you do not have to accept the defendants’ behavior and efforts to prey on physicians’ lack of familiarity with assessing work status.
Instead, hire a skilled attorney to ensure you receive accurate and complete permanent restrictions after spinal fusion and only return to a job you can perform without risk of re-injury. Then create an action plan to scare the insurance adjuster into increasing claim reserves and offering a fair settlement.
Call us today to get started: 804-251-1620 or 757-810-5614.
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