General Guideline Principles for Disc Herniation and Other
Cervical Conditions for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Disc Herniation and Other Cervical Conditions.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Disc Herniation and Other Cervical Conditions

Operative therapy is only recommended when a problem’s natural history is preferable to the problem’s natural history in the absence of operative treatment.

To point out pain generators that may retort to nonsurgical treatments or may be resistant to surgical intervention, all patients being evaluated for surgical intervention should have a thorough neuromuscular evaluation. To prevent cervical spine deconditioning and increasing impairment, timely surgical decision-making is essential.

It is advised that the patient stop smoking at least six weeks before surgery and during the recovery process if the cervical combination is being considered. It is advised that insurance cover a smoking cessation program peri-operatively since smokers have a great danger of non-union and greater post-operative expenditures.

General Indications for Surgery: When symptom recovery has stalled, and the remaining symptoms of pain and functional incapacity are intolerable, surgical intervention should be considered. Typically, surgical consultation should follow at least six months of non-surgical care that complies with recommended medical care.

Patients who have considerable and/or developing neurologic impairments can be candidates for surgery early. The surgeon’s clinical judgment, the patient’s pathology, and the surgeon’s selection of hardware instrumentation are all taken into consideration.

Specific Surgical Indications

• Myelopathy of Disc Herniation and Other Cervical Conditions

  Myelopathy of Disc Herniation and Other Cervical Conditions is recommended in a few individuals, as clinically necessary

  Indications: Myelopathy patients should be evaluated and treated surgically right away.

  Cervical Radiculopathy of Disc Herniation and Other Cervical Conditions

  Severe incapacitating pain or the presence of severe or increasing neurological impairments may call for early intervention.

  After six weeks of conservative therapy, there is persistent or recurring arm discomfort with functional restrictions; a growing functional neurological deficit; a static neurological deficit accompanied by severe radicular pain; and imaging investigations that support the clinical findings.

  Persistent Non-Radicular Cervical Pain of Disc Herniation and Other Cervical Conditions

  There is no strong proof that cervical fusion for neck pain alone yields results that are better than conservative therapy, even if it is a suitable treatment for neck pain caused by degeneration with radiculopathy. Before committing to surgical surgery, it is advised to exhaust all conservative therapies in the deprivation of radiculopathy.

  Cervical vertebral fusion has not been proven to be useful for pain that is not radiating. As a result, it shouldn’t always be suggested. All the following prerequisites must be met in victims with non-radicular cervical discomfort before fusion may be considered.

  Operative therapy may be recommended if the non-operative treatment approach is unsuccessful if:

• After six to twelve weeks of active therapy, or after a longer-term non-operative program for disabled patients with complicated difficulties, the symptoms’ improvement has plateaued, and the residual pain and functional incapacity are intolerable
• Even if a non-functional active therapy program successfully relieves symptoms and restores function after each recurrence, frequent recurrences of indications nevertheless result in substantial functional restrictions.
• An active treatment program is not only the passing of time with poorly directed care.
• All sources of discomfort have been effectively identified and addressed.
• The patient’s symptoms have not improved after using physical medicine and manual treatment procedures.
• showing spinal instability or disc disease on an X-ray, MRI, or CT scan
• a two-level limit to the spine’s pathology.
• Confounding factors for psychosocial assessment are addressed.
• It is advised that the patient stop smoking at least six weeks before any probable operation and for the duration of the recovery process. It is advised that
• insurance support a smoking cessation program pre-operatively since smokers have a great danger of non-union and greater post-operative expenditures.

Surgical Procedures

1. Surgical Procedures

   Surgical Procedures are recommended clinically appropriate in a subset of individuals. Surgical techniques comprise:

2. Cervical Discectomy with or without Fusion of Disc Herniation and Other Cervical Conditions

   Description: Procedure to release pressure on the spinal cord or more than one and more nerve roots. It can be carried out with or without a microscope.

   Complications: A catastrophic spinal cord injury producing varied non-union of amalgamation, degree of paralysis, hospital mortality, pseudarthrosis, donor site discomfort, graft dislodgment, infection, hemorrhage, CSF leak, hematoma, and catastrophic spinal cord damage (autograft only). Anterior approach: airway blockage, denervation, esophageal perforation, permanent or temporary dysphonia, and permanent or temporary dysphagia.

   Surgical Indications: Spinal instability, radiculopathy from disc prolapse/herniation or spondylosis, or those with non-radicular neck discomfort who fit the fusion criterion

   Operative Treatment: Cervical plating can be used to improve fusion rates and avoid graft displacement.

   Post-Operative Care: According to what is clinically necessary, cervical bracing, physical therapy, and/or occupational therapy may be needed. Early in the rehabilitation phase, home programs including teaching in a daily walking program, ADLs, posture, and sitting should be implemented.

   Once the fusion is stable and free of complications, referral to a comprehensive rehabilitation program is necessary. This program should focus on strengthening the scapular, cervical and thoracic regions as well as restoring the range of motion.

   Active therapy, which victims should have had before surgery, usually necessitates repeating the sessions that were originally prescribed. The treatment program’s objectives should include teaching patients how to follow a long-term, at-home fitness regimen.

3. Cervical Corpectomy

   Description: Removing all or a portion of a vertebral body in front of the spine will typically require a fusion procedure and at least one level of discectomy.

   Complications: A catastrophic neck backbone injury producing varying degrees of paralysis, hemorrhage, CSF leak, hematoma, pseudoarthrosis, in-hospital death, non-union of fusion, and donor site discomfort are possible complications (autograft only).

   Anterior approach: airway blockage, denervation, esophageal perforation, permanent or temporary dysphonia, and permanent or temporary dysphagia.

   Surgical Indications: Spinal stenosis with cord compression at one or more levels, spondylolisthesis, or severe kyphosis.

   Operative Treatment of Disc Herniation and Other Cervical Conditions

   Neural decompression, fusion using equipment, and potential insertion of a halo vest to keep the cervical posture.

   Post-Operative Care: According to what is clinically necessary, cervical bracing, physical therapy, and/or occupational therapy may be needed. The healing process might take longer than discectomy depending on how many vertebral bodies are involved.

   Halo vest maintenance has historically been necessary, however, modern methods of cervical combination with instrumentation may allow for quicker mobility.

   Early in the rehabilitation phase, home programs including teaching posture, daily walking routine, ADLs, and sitting programs should be implemented.The majority of patients should be sent to a structured rehabilitation program with a focus on strengthening the thoracic, scapular, and cervical regions. without difficulty the therapeutic program’s objectives should be a long-term, home-based workout regimen with teaching included.

4. Cervical Laminectomy with or without Foraminotomy and/or Fusion of Disc Herniation and Other Cervical Conditions

   Description: the surgical excision of a vertebra’s posterior part to provide access to the neck backbone injury or nerve roots.

   Complications: These conditions might be perineural fibrosis, kyphosis, nerve damage, post-surgical integrity, infection, CSF leak, failure of the hardware, non-union of the fusion, discomfort at the donor site (only for autografts), paralysis, or even death.

   Surgical Indications: brain compression

   Operative Treatment: Laminectomy, nerve root decompression, and partial discectomy.

   Post-Operative Care: According to what is clinically necessary, cervical bracing, physical therapy, and/or occupational therapy may be needed. Therapy: Although more recent surgical procedures might not necessitate lengthy immobilization, cervical bracing may be necessary (often for six to twelve weeks with fusion).

   Early in the rehabilitation phase, home programs including teaching in sitting, daily walking routine, ADLs, and posture programs should be implemented. Once the cervical spine is determined to be stable and devoid of complications, referral to a professional rehabilitation program with an emphasis on strengthening the scapular, cervical, and thoracic muscles and restoring range of motion is acceptable for many patients.

   The long-term home exercise regimen should be taught as part of the therapeutic program’s objectives.

5. Cervical Laminoplasty of Disc Herniation and Other Cervical Conditions

   Description: Technique that lengthens the spinal canal while maintaining some of the posterior structures.

   Complications: Cervical motion loss These conditions might be perineural fibrosis, kyphosis, nerve damage, post-surgical integrity, CSF leak, infection, failure of the hardware, non-union of the fusion, discomfort at the donor site (only for autografts), paralysis, or even death.

   Surgical Indications: Spinal stenosis in the cervical region and/or spondylitis myelopathy in cervical kyphosis, not recommended.

   Operative Treatment: A posterior approach, instrumented or not.

   Post-Operative Care: According to what is clinically necessary, cervical bracing, physical therapy, and/or occupational treatment may be needed. cervical bracing for four to twelve weeks may be part of the treatment.

   Early in the rehabilitation phase, home programs including teaching in posture, ADLs, daily walking plans and sitting programs should be implemented. Once the cervical spine is secure and free of complications, referral to a professional rehabilitation program is recommended, with a focus on strengthening the cervical, scapular, and thoracic muscles and restoring range of motion.

   Active therapy, which patients should have had before surgery, usually necessitates repeating the sessions that were originally prescribed. A long-term, home-based fitness routine should be taught as part of the therapeutic program’s objectives.

6. Percutaneous Discectomy

   Description: An invasive surgical treatment that involves aspirating a piece of the disc while under imaging control to partially remove the disc.

   Complications: Include, but are not restricted to, infections, hematomas, and harm to the nerves or blood vessels.

   Surgical Indications- Only in cases of conjectured septic discitis should a percutaneous discectomy be performed to obtain diagnostic tissue. For confined disc herniation/prolapse or bulges with accompanying radiculopathy, the operation is not advised since there is insufficient data to indicate long-term benefit.

   Operative Treatment: discectomy in part.

What our office can do if you have workers compensation Disc Herniation and Other Cervical Conditions

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.