Written by: Stephen P. Banco, MD, FAAOS
Board-Certified, Fellowship-Trained Orthopaedic Spinal Surgeon
Neck and low back pain are common workers’ compensation injuries that we treat every day at Keystone Spine & Pain Management Center (KSPMC).
Due to the specific nature of workers’ compensation in the state of Pennsylvania, these injuries can be frequently mishandled. Many times, neck and arm pain can be labeled as a simple neck strain. Likewise, low back and leg pain can be labeled as a simple low back strain. Unfortunately, in this situation, patients can be referred to physicians who are not spine specialists and may be inexperienced in treating spinal pain. Patients often feel like pawns of the system without getting better.
Frequently, these “strains” are actually herniated discs in the neck or low back with debilitating spine and extremity pain. They have been improperly treated with unproven treatments such as pain creams, laser braces, and ice therapy. These treatments do not meet the standard of care for treatment of neck pain, low back pain or sciatica.
Keystone Spine & Pain Management Center, has been treating workers’ compensation injuries for twenty years. We advocate for the injured worker to be properly diagnosed, appropriately treated, and returned to work as soon as possible. Helping the patient return to function and return to work is the goal in these complex workers’ compensation cases.
Our goal at KSPMC is to diagnose and treat the injured worker as soon as possible. This can consist of anti-inflammatory medication, physical therapy, epidural steroid injections or surgery. While our focus is nonoperative therapies, there are times when surgery is necessary and appropriate to alleviate symptoms. We do not allow the symptoms to linger for months on end.
Furthermore, Keystone Spine & Pain Management Center providers interact with case managers and employers to ensure optimal treatment results for the injured worker. Frequently, the injured worker needs to be placed on restricted duty and our spine specialists will create limited duty treatment plans to allow the patient to slowly progress back to full duty.
Neck and Arm Pain
Heavy and frequent lifting can result in severe neck and arm pain. The most likely diagnosis is a sprain and strain. These types of injuries are treated best with rest, anti-inflammatory medications and Physical Therapy. They improve rapidly and last for approximately six weeks. If the pain does not improve with PT, an MRI is obtained to determine the presence of a herniated disk.
Herniated disks are easily diagnosed on MRI. It will reveal a piece of the disk between the bones of the spine protruding out of its normal location and compressing a nerve in the same area. This nerve root compression causes arm pain or “radiculopathy”.
Patients with a herniated disk, who have failed physical therapy, are candidates for an epidural steroid injections. This procedure is performed in a hospital or surgery center under local anesthesia or mild sedation.
The epidural injection places steroid around the nerve, not into the nerve, being compressed. This procedure is designed to decrease the inflammation caused by the disk herniation. We can repeat this process 2-3 times in a few weeks. The success rate of the injections is approximately 60-70%. Failure of physical therapy and epidural injections leads to surgery.
The last step in the treatment of a disk herniation is surgery. Usually, it requires a procedure called an Anterior Cervical Diskectomy and Fusion(ACDF). This procedure removes the entire disk from between the bones of the spine in the neck and replaces it with a cage or bone graft supported by a plate and screws.
The success rate of this surgery is approximately 95% with minimal pain and usually an overnight stay in the hospital. A Spinal Surgeon should be consulted prior to any surgery.
Back and Leg Pain
Heavy and frequent lifting can result in severe back and leg pain, similar to the cervical spine. Again, the most likely diagnosis is a sprain and strain treated best with rest, anti-inflammatory medications and Physical Therapy. They improve rapidly and last for approximately six weeks. If the pain does not improve with PT, an MRI is obtained to determine the presence of a disk herniation. As in the neck, low back herniations can cause leg pain or “Sciatica”.
Patients with a herniated disk in the low back are treated the same as patients with herniated disks in the neck. Epidural steroids are the mainstay of treatment and if these fail, surgery is the next option.
Diskectomy vs Fusion
Surgery in the lower back for herniated disks is similar to the neck. Usually, a small diskectomy can be performed to remove a portion of the disk. However, there are instances a patient may require a fusion for treatment. A complete evaluation by a Spinal Surgeon must be performed before making any decision.