There’s no doubt that life-changing chronic back pain can interfere with a person’s quality of life, both at work and at home. Chronic back pain is typically is defined as severe back pain persisting beyond normal medical healing time, usually lasting for more than six months.
Unfortunately, many occupations, such as jobs that require sitting, standing and moving (such as nursing, dentistry, plumbing, construction, warehouse jobs, sitting in court) can place significant demands on your back. For example, if you suffer from back pain and your job involves significant sitting, lifting, bending, crouching, kneeling, stooping or standing, you may be prevented from performing the substantial duties of your occupation.
It all depends what your long-term disability policy says, as definitions vary. Typically, most policies will cover you as the claimant against the inability to perform the “substantial duties” of your own occupation for the first 24 months of disability. Normally, this refers to the occupation that you are engaged in at the time that you became disabled. This does not mean you have to be totally helpless in order to collect disability benefits, but you must be unable to complete the substantial duties of your own occupation. You have the onus of proving your disability, and that onus is determined on a balance of probabilities or, if a reasonable person in the circumstances would recognize that you should not work.
After 24 months, most policies change definitions. There is a transition from being unable to perform the substantial duties of your own occupation to that of “any occupation”. This transition from own occupation to any occupation is a very important juncture in a disability claim. If you are unable to complete the duties of any occupation in which you are reasonably suited by education training and experience, you may be considered totally disabled until – you are no longer disabled from any occupation, or until you turn 65 (or beyond 65 in some policies) and under some circumstances, until an earlier date if, for example, you fail to comply with the terms of the policy, or until death.
Long-term disability carriers will typically look at your physical and mental condition, your age, your work history, your professional skills, any skill development courses you have taken will working, your stress toleration, energy levels, pain levels, cognitive levels, consistency, your credibility and your endurance.
If you have suffered traumatic or long-standing wear and tear type of back pain and are unable to work it’s important that you apply for long-term disability sooner than later. If you are unable to work and you have been wrongfully denied your disability benefits, or cut off long-term disability at any stage of the disability process, it’s important to retain a disability lawyer to assist you in appealing your disability claim or in the alternative filing suit against your disability carrier for a declaration or decision that you are in fact disabled and your insurance carrier should reinstate your long-term disability benefits.
Your spine is a bony tube which protects your spinal cord and nerve roots and help you maintain mobility with the repetitive discs in front and two facet joints in back. Your spine is divided into sections:
Disc Herniations – Disc herniations are extremely common and mostly encountered in the cervical and lumbar spine. Your spinal discs are located between the bones of your vertebrae and provide a cushion or “shock absorber” for your spine as you move. Your discs are made up of two parts – the center, called the nucleus pulposis, which is spongy gel-like substance that provides most of your disc’s ability to absorb shock. The nucleus is held in place by the annulus, which are strong tire-like ligament rings around the nucleus. When discs split or ruptured, the inner gel-like substance leaks out or pushes up against the outer-ring. This is called a herniation of the nucleus pulposus— or a herniated disc – which puts pressure on the sensitive spinal nerves, causing pain. The clinical result most commonly involves pain in the distribution of the compressed nerve root that exits your vertebrae.
The most common cervical disc herniation is at the center of the neck, C5-6, and the typical pain syndrome includes headaches, muscle spasm in the muscles of the neck and shoulder pain, and pain radiating along the C6 nerve into the index finger and thumb.
The most common lumbar spine disc herniations occur at the L4-5 or L5-S1. Typical clinical findings include muscle spasm, pain in the buttocks, and pain radiating to the foot. These symptoms attenuate, and in 90 percent of cases, a tolerable baseline is reached by three months post-injury.
If there is a failure of your symptoms to improve over six weeks, your doctor will, more likely than not, schedule an MRI which would provide visualization of the soft tissue structures of your spine. If your MRI returns remarkable, indications for surgery are failure to improve by 12 weeks, intolerable pain, progressive motor deficits, or bowel and bladder dysfunction.
Disc Protrusions or Bulging Discs – if you injure the annulus, or the wall around the nucleus, the wall can then weaken and the nucleus can press outwards on the weakened disc wall, causing your disc to bulge outwards or form an “outpouching”, which can press against spinal nerves. If the outpouching is severe enough to cause the nucleus to leak out of the annulus, then a herniation will occur. A disc protrusion is often referred to as a slipped disc – symptoms of which can cause localize neck or back pain or pain hat radiates into the arms or legs, cause numbness and tingling, mobility issues, weakness and dexterity issues.
A protrusion or bulging disc can be caused by traumatic force, or by wear and tear – i.e. the annulus may have been pre-existingly weak. “Wear and Tear” can also be defined as repeated micro-trauma, a situation in which small amounts of trauma over an extended period of time can result in stress on the spine – such as heavy work or bad posture. If your protrusion bulging disc has persisted over six months, or is causing you bowel or bladder problems, extreme weakness in your limb muscles, reduced or altered sensation such as pins and needles, extreme sciatica or referred pain, or unbearable spinal pain, it’s best that you see your doctor as soon as possible.
Spinal Stenosis – Spinal stenosis, is the “constriction of your spinal canal.” Normally stenosis is not acute in nature, unless it was caused by a disc herniation, which could diminish the size of your spinal canal. In this condition, the cushion available for nerve tissue within your spinal canal is reduced, and an acute trauma, which under ordinary circumstances would not lead to significant injury, consequently leads to considerable and occasionally irreversible symptoms. In some cases, surgery may be warranted – which would consist of decompression or removal of the compressing portion of the spinal canal. This is most typically accomplished by a surgery called “laminectomy”.
Fractures of the spinal column are the most unstable of all injuries. When the fractures involve the parts of your vertebra that are sites of muscle attachment, you can typically be treated with supportive management, bracing, rest, and analgesics. When the fracture threatens the stability of your spine, it must be treated with fixation and fusion.
The burst fracture – the most common type of fracture necessitating fusion and internal fixation is a so-called burst fracture. This typically results from situations such as diving into a shallow pool and striking one’s head. The vertebra tends to “explode”and fragments of bone become displaced into the spinal canal, causing or threatening neurological problems.
Dislocation of the Spine – are serious injuries that almost uniformly require operative treatment. This disorder results from violent rotation or hyperflexion of the spine and is commonly associated with neurologic damage. A rare but potentially devastating complication of dislocation in the cervical spine can result from unrecognized disc herniation.
Compression Fractures – compression fractures occur when the there is sudden downward force that shatters the vertebrae and causes it to collapse – similarly to crushing a can of soda. The measurement of level are made of “loss of height.” If there is a significant loss of height and treatment if attended to quickly enough, then a surgery called “kyphoplasty” which stabilizes the bone by injections of cement.
Wedge Fractures – are extremely common type of compression fracture that occurs anteriorly and laterally and more commonly found in the thoracic area of the spine. Wedge fractures affect the height of the vertebral body. Generally there is no neurological disruptions, however these types of fractures are considered quite serious when anterior wedging is 50%, or bone fragment(s) are suspect in the spinal canal.
Kyphoplasty – is typically used to repair compression fractures of the vertebral bones caused by traumatic forces or osteoporosis. The procedure includes the injection of a bone cement that is quite glue like which hardens and strengthens the bone, preventing further compression.
Laminectomy – this is the type of surgery used when spinal stenosis causes your spinal canal to narrow, which results in pain and weakness. A laminectomy would involve the removal of the bony walls of your vertebral bones, as well as any bone spurs. The point of the surgery is to widen or open up the spinal column to relieve pressure on the nerves.
Discectomy – this is a type of surgery used to completely remove a disc when it has herniated and is pressing on your spinal cord or nerve roots. A laminectomy and discectomy are surgeries that are often performed together.
Spinal fusion – a spinal fusion is when discs are removed between vertebrae. Spinal fusion can also be multilevel, meaning that more than one disk is removed and replaced between vertebral bones. Bone grafts are then inserted as a replacement and to stimulate bone healing. Spinal fusion does eliminate motion between the vertebrae and prevents the stretching of your nerves and surrounding ligaments and muscles. Spinal fusion is recommended to relieve back pain caused by fractures, broken spinal bones, spinal stenosis, degenerative disc disease, tumors, spine infection or scoliosis. Spinal fusion could be done anteriorly or from the back. Rods and pedicle screws are used to stabilize the vertebrae.
Artificial disc replacement – (ADR) is now considered an alternative to spinal fusion for the clinical treatment of accident victims with severely damaged discs. A synthetic disk is used which helps to restore movement and height between the vertebral bones. It’s been noted in orthopedic journals that artificial disc replacement offers a more rapid return to normal daily activities then fusion surgery.
If you have suffered a permanent life changing back injury and you have been denied your long term disbility, call us today at 905-333-8888, or fill in a contact form and our office will get back to you quickly to answer all of your questions. We have litigated against all major disability carriers and have represented disability claimants since 2003. Our expert disabilty lawyers are here to make a difference and help get your disabilty benefits back on track.
**Thank you to Orthoinfo, AAJ, Pubmed and Dr.Jeffrey Kleiner for this information.