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.

Call Us Now!

Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.