I Suffered A Work Injury And Now I Need Surgery. What Should I Do?

Though I'm a workers compensation attorney first and foremost, I also consider myself an advocate for informed health care decisions. Following my own work injury many years ago, I have undergone multiple back surgeries over the years (knock on wood I'm doing very well). Because of the same, injured workers are often drawn to me for this very reason. I can relate to what they are going through when making informed decisions about whether to proceed with a surgery. This brings me to surgeries performed on older injured workers. I share this story as another resource (click here)  in the decisions you make. If you are an injured worker and a surgeon has recommended surgery, never be afraid to seek a second opinion.  You get one chance at this decision!  Inform and educate yourself to make the best decision for you and your family.  

I Suffered A Minnesota Workers Compensation Injury. Do I Need Back Surgery?

Though I've been a Minnesota workers compensation attorney my entire legal career, that's the very same question I asked myself nearly 20 years ago.  Do I need lumbar spine surgery.

I was injured at work and despite conservative care, my radicular leg and back pain left me unable to sleep and barely able to function.  Over time I grew frustrated, short tempered and frightened about my future.  Despite being a young lawyer, I was worried that I wouldn't be able to do my job given my inability to sit or stand for extended periods of time; a prerequisite to being a trial lawyer.  I was taking narcotic medications that left me fuzzy at best and only took the edge off my pain.  I want to share with you what I've have learned over the past few decades since my injury and lumbar spine surgery.

Over the years I have handled or represented over a thousand cases involving spinal cord injuries.  I'm unique in being the only Minnesota work comp attorney who has sustained a spinal cord work related injury.  In fact, I have undergone three spinal surgeries since 1992.  Lucky me right?  Twentyfive years later spine surgeries have dramatically changed and in most cases improved.  During this time I have seen aggressive use of lumbar and cervical fusions, the introduction of artificial discs, and development of spinal cord stimulators.

Most lawyers are hesitant to offer advice on surgery because they haven't had the same.  Though I'm a workers compensation attorney, I feel obligated to be a "counselor" as well.  I encourage my clients to explore conservative treatment and only enter into the decision of spinal surgery after the same.  I also make sure that they understand that though surgery can relieve their symptoms, in rare situations their conditions could worsen.  I offer the names of physicians and clinics that have a proven track record of having, "good hands, good heads and good hearts".  I consider myself lucky that my surgeries have turned out extraordinarily well.  I am 100% pain free.

I often blog that not all workers compensation attorneys are equal and that experience matters.  This applies to orthopedic surgeons and neurosurgeons as well.  Like some lawyers I know, a surgeon may come across as confident and a smooth talker.  This doesn't mean they are either good in the courtroom or in the operating room.  Surgeons can be overconfident of their talents and fail to communicate or even know the long term outcome of their surgical patients.  Very few have patient follow up beyond 3-6 months post surgery.  If the patients having ongoing or worsening pain and are non surgical there is usually nothing a surgeon can offer you and they wash their hands with you.  In fact, in many cases the last time you see your surgeon is just before the surgery or while recovering at the surgical center or hospital.  Often follow up care is performed by nurse practitioners or physicians assistants.  Remember; "good hands, good heads and good hearts".  It's rare to find a surgeon with both.

If you sustained a work injury and want to discuss the surgery, I'm happy to sit down with you for free and listen and discuss with you your options.  A decision to undergo surgery is a personal decision and I will never tell you to do the same.  I will simply share with you what I have experienced personally and in the thousands of workers compensation cases I have been involved with over the last 25 years.  With this information you can hopefully make a more informed decision of what is best for you and your family.  Contact us today at 651-333-3636 for a free consultations.  Every single one of our attorneys has been honored as a Superlawyer and is a workers compensation expert.  Visit us at www.mndisability.com for more information.  Also visit our video center for answers to many of your questions.  Our phones are answer 24/7 and in many cases you can talk to a lawyer anytime of the day or night.

Can The Work Comp Insurer Cut Off My Pain Meds?

Recently the Minnesota Department of Labor and Industry erected hurdle for injured workers using pain medications following a Minnesota workers compensation injury.  The purpose of the change is allegedly two fold; first to reduce costs for insurers and second to stem pain medication abuse.  Having undergone three spine surgeries myself, I know first hand the benefits of narcotic medications.   Recovery from surgical procedures can be brutal.  However, I think that insurance companies have led the way in pushing for these changes for one reason.  Can you guess?  Correct, it's to save money.

Can insurance companies therefore stop paying for your pain meds?  The quick answer is maybe.  But with sound legal advice you can successfully fight them.  As with all medical treatment and benefits, it's critical that your doctors not only document why they are prescribing a particular medication but also follow the newly enacted guidelines.  The new guidelines require your doctor to do the following:

• Affirm that you can't maintain functions of daily living without the medication, don't have "somatic symptoms disorder", don't have a history of failure to comply with treatment, and no history of substance abuse.
• Ensure all other forms of pain management options have been exhausted.
• Identify whether there are factors that could complicate your use of narcotic medications; pregnancy, suicide risk, history of substance abuse, heart issues, etc.
• Complete a "scientific assessment" to determine your risk of abuse.
• Explain potential complications of using long term pain pills.
• Finally you must enter into a written contract with your physician which includes the possibility of random drug testing.

At Atkinson Law Office we have created an easy form for your physician to complete.  This ensures that there is no interruption in medications.  Usually once your doctor completes this form, our attorneys can work with your insurance company to continue your medications.  They may have you see an "independent medical examination" by an adverse doctor.  If you receive notice of the same CALL AN ATTORNEY IMMEDIATELY.  This means they will be cutting off your meds very soon. The lawyers of Atkinson Law Office have successfully litigated numerous cases and successfully helped clients have a quality life despite significant injury.  If you would like to discuss this or any other workers compensation questions with a Minnesota workers compensation expert, call today at 651-333-3636.  Our phone are answered 24/7.  We represent clients across the entire state of Minnesota.

You Have A Minnesota Work Injury And Need Spine Surgery. Should You Go With A Traditional or Laser Lumbar Spine Surgery?

Like many of you contemplating low back surgery, I was aware of the option of laser spine surgery before I underwent two low back surgeries following my Minnesota work comp injury.  I did a lot of research on the issue before deciding to go with the traditional microdiscectomy over the "laser" approach.  Though every individual has to come to their own decision as to surgery, I feel that treating with a local spine surgeon here in Minnesota is the smartest choice.  That said, I want to stress that just like workers compensation attorneys, all surgeons are NOT equal.  We are fortunate to have many excellent spine surgeons here in Minnesota.

In reading the numerous studies (not Laser surgery center advertisements) I have found that there is no real significant benefit for undergoing a laser spine surgery procedure.  In fact, the biggest downside is that our Minnesota workers compensation clients often have to travel to far flung states like Florida or Arizona to undergo a laser spine surgery.  This makes follow up care, treatment for complications, and building a relationship with a physician nearly impossible and horribly expensive.  In addition, often you need to rely on your doctor for a medical legal opinion as to whether your work injury is a substantial contributing cause to your surgery.  Too often doctors from outside of Minnesota simply don't understand Minnesota's complex "causation" standards or don't want to get involved in an out of state legal proceeding.  This should be a real concern for you as a patient and injured worker.

As for minimally invasive laser spine procedures, Dr. H. Gordon Deen, a neurosurgeon at the Mayo Clinic stated in a 2009 Mayo publication that "there are no clear benefits to laser surgery over more well-established spine surgery techniques that have proven to be effective."   Dr. Deen went further and stated that doctors at the Mayo Clinic neither use nor recommend laser spine surgery.  Having personally worked with dozens of other Twin Cities spines surgeons I can attest that his opinions are universal here in Minnesota.

If you have sustained a work related low back or cervical spine injury and are contemplating surgery, I'm happy to discuss these with you both as an expert workers compensation attorney and as a someone with personal experience having undergone spine surgery. There is never a charge to discuss the same.  I'm truly open to talking to you in person or by phone.  With over nearly 25 years experience in workers compensation and having had multiple spine surgeries, nobody is more qualified than me to advise you with your injury.  Call today at 651-333-3636 or visit our page at www.mndisability.com 

I Had A Minnesota Work Related Back and Neck Injury, What Do I Tell My Doctor?

This article is prompted by a phone call I received this afternoon from an existing client with a hand injury who now sustained a more serious back injury a year later.  She was concerned about filing "another work injury" and is hoping her back gets better and she doesn't want to report it to work despite missing a week of work.

She is well intentioned but is making an enormous mistake that I have seen countless times.  If you have a work injury that results in lost time from work or you need to seek medical care then you MUST report it.  It's the law.  Your employer must complete a First Report of Injury because that's the law.  Why is this the law?  To protect YOU the injured worker when the employer later tries to deny the injury or minimize it.  It's true that most back injuries resolve shortly after the incident on there own with simple rest, ice, and core strengthening.  But there are times when it doesn't and this action or inaction will greatly hurt your chances for fair treatment by the employer, insurance company and adverse doctors.

When you first see your health care provider, you will be asked questions about your back pain, including how severe it is, how it happened and where it happened.  Tell the doctor clearly and repeatedly where it happened and how it happened. 

Your doctor or chiropractor will try to determine the cause of your back pain and how to best treat it.  The pain will likely get better with simple measures such as ice, medication, physical therapy, and  exercises.  However, some symptoms such as radicular pain down your arms or legs can be immediate signs of a far more serious injury.  Your doctor may order an X-ray, CT Scan, MRI or an EMG to rule out a more serious injury.  This is an excellent time to call a lawyer for a free consultation. 

Please, if you have sustained a neck or back injury at work, tell your supervisor and then see a doctor.  Don't assume your doctor knows you had a work injury.  Tell them directly, don't assume the nurse or intake assistant clearly advised them of the nature of your injury.  Be your own advocate.

If you have sustained a Minnesota work related injury contact attorney Tom Atkinson or Kerry Atkinson today.  Atkinson Law Office and Minnesota Disability have a staff dedicated to assisting Minnesota work injuries.  Kerry and Tom have been working with Minnesota work injuries for over 20 years.  Both Tom and Kerry formerly represented employers and insurers but now only represent employees!  We are waiting to share the secrets they have learned to assist you to win your case.  There is never a fee collected to meet with them nor a fee paid unless there is a recovery.  Your initial consultation is always free as well.  Call today 651-333-3636 and visit our website www.mndisability.com 

I Have Had Both Neck Surgery And Back Surgery; Do You Need Back Or Neck Surgery?

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Since my neck surgery I have run a marathon, and following my back surgeries I have run a half marathon and many 10k races.  I share this with you not so that you take surgery lightly, but to recognize that there are very successful outcomes to back and neck surgery.  

For most injured workers, spine surgery is “elective”, meaning that it is considered as a possible approach to enhance an injured worker’s ability to function and decrease pain. However, just because spine surgery is elective or recommended by a spine surgeon does not mean the workers compensation insurance company will agree to pay for it.  Almost without exception, the work comp insurer will require an independent medical examination.

"Elective" just means that surgery of the spine is rarely an absolute necessity. Like myself, most often surgery is performed to relieve significant pain or reduce symptoms such as radiating pain, numbness or tingling down one’s legs or arms.  Only in rare instances, such as for patients who have a progressive neurological loss of function or sudden onset of bowel or bladder incontinence, is spinal surgery actually necessary on an emergency basis.

Spine surgery can basically accomplish two tasks:

1. Decompress a nerve root or the spinal cord
2. Stabilize an unstable or painful segment with cervical, thoracic or lumbar fusion

Some injure workers with back or neck pain wonder by a surgeon doesn’t perform exploratory surgery.  I have never heard of exploratory spine surgery. The cause of a patient’s pain is not readily apparent with opening and exploring the spine. The preoperative evaluation and imaging results are what identify the problem and guide the design of the procedure.

If you have been injured, contact the attorneys of Minnesota Disability and Atkinson Law Office, P.A. For a FREE consultation call 651-333-3636.  Our phones are answered 24 hours a day.

What Is SI Joint Pain?

Sacroiliac joint pain

What is Sacroiliac (SI) joint pain? SI joint pain has gained a lot of attention in the last ten years as an under appreciated cause of back pain with some studies indicating it is responsible for 15% to 40% of low back pain. The increased attention is due to the increasing knowledge of the SI joints intimate role in pelvic stability. I hope more physicians consider SI joint pain in their differential after reading this article.

Pathophysiology

SI joint dysfunction due to inflammation within the joint itself is called sacroilitis. Pain from within the SI joint is common in rheumatoid patients and spondyloarthropathies.

The other cause of SI joint dysfunction can result from instability of the SI joint following a work injury. Many experts feel that SI joint pain is a component of a larger problem of pelvic instability. Pelvic instability has traditionally been underappreciated as a cause of low back pain, buttock pain, groin pain, and leg pain. Physical therapists and doctors of osteopathic medicine have been teaching these concepts for years but only relatively recently has this dissemination of knowledge trended towards mainstream thinking among medical doctors.

The SI joint complex (the SI joint and its associated ligaments) is the major support structure of the pelvic ring and is the strongest ligament complex in the body. The complex consists of interosseous sacroiliac ligaments, iliolumbar ligaments, posterior sacroiliac ligaments, and the sacrotuberous and sacrospinous ligaments. The SI joints are two of the three joints involved in the stability of the pelvic ring. The pelvic ring is the meeting place of the force vectors from the upper body and the lower extremities. The third joint in the pelvic ring is the pubis symphysis. Pelvic instability causes pelvic rotation which can also cause twisting of the pubis symphysis. Coupling this with its anterior location appears to provide an explanation as to why patients with SI joint instability can also experience anterior groin pain. Anecdotal evidence for this is seen when patients undergo a successful SI joint intra-articular injection relieving all of their posterior back, buttock, and leg symptoms but the patient still has groin pain. Groin pain is almost never eliminated by SI joint injections unless pelvic symmetry is corrected.

If the SI joints are unstable, it can lead to significant pain and discomfort over the SI joints as well as numerous referred areas. If an individual affected by SI joint pain has pain only over his or her SI joint, he/she should be considered lucky. Most often SI joint instability causes unnatural strain on the entire low back and pelvic region causing a sometimes confusing clinical picture. Pain referral patterns of SI joint pain are often confused with L5 or S1 radiculitis or radiculopathies.

If you suffered a work injury let Atkinson Law Office P.A. & Minnesota Disability help you obtain the answers you need TODAY! We have worked with physicians and specialists throughout Minnesota to help injured workers find the answers to their injuries for nearly two decades. Contact attorney Thomas Atkinson directly at 651-324-9514 or email at tom@mndisability.com You may find additional information at our website www.mndisability.com

Exploring Back Surgery - Part III

A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery, and all involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment.

For patients with the following conditions, if abnormal and excessive motion at a vertebral segment results in severe pain and inability to function, a fusion may be considered

• Isthmic, degenerative or postlaminectomy spondylolisthesis.

Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis or deformity.

How spine fusion surgery works

At each level in the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment and permit multiple degrees of motion. Two vertebral segments need to be fused together to stop the motion at one segment, so that an L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is actually a one-level spinal fusion.

A spine fusion surgery involves using bone graft to cause two vertebral bodies to grow together into one long bone. Bone graft can be taken from the patient's hip (autograft bone) during the spine fusion surgery, harvested from cadaver bone (allograft bone). or manufactured (synthetic bone graft substitute).

In general, a lumbar spinal fusion surgery is most effective for those conditions involving only one vertebral segment. Most patients will not notice any limitation in motion after a one-level spine fusion. Only in rare cases should a three (or more) level fusion surgery for pain alone be considered, although it may be necessary in cases of scoliosis and lumbar deformity.

When necessary, fusing two segments of the spine may be a reasonable option for treatment of pain. However, spinal fusion of more than two segments is unlikely to provide pain relief because it removes too much of the normal motion in the lower back and places too much stress across the remaining joints.

There are several types of spinal fusion surgery options, including:

• Posterior lumbar interbody fusion (PLIF/TLIF))—the procedure is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

• Posterolateral gutter fusion—the procedure is done through the back

• Anterior lumbar interbody fusion (ALIF)—the procedure is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

• Anterior/posterior spinal fusion—the procedure is done from the front and the back

Exploring Back Surgery - Part II

Like some of my clients, I sustained a work related back injury resulting in the need for surgery. In Part II of Exploring Back Surgery, I will discuss the procedure I underwent to repair a large free fragment disc herniation in my back.

A discectomy is a surgery done to remove a herniated disc from the spinal canal. When a disc herniation occurs, a fragment of the normal spinal disc is dislodged. This fragment may press against the spinal cord or the nerves that surround the spinal cord. This pressure causes the symptoms that are characteristic of herniated discs.

The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure on the nerve. This procedure is called a discectomy. The traditional surgery is called an open discectomy. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve.

How is a discectomy performed?
A discectomy is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.

In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.

Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating in the future. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

What is the recovery from a discectomy?
Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.

What is endoscopic microdiscectomy?
This is a newer technique utilized by my surgeon. This technique may allow your surgeon to perform a procedure called an endoscopic discectomy. In an endoscopic discectomy your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. Your surgeon uses x-ray and the camera to "see" where the disc herniation is, and special instruments to remove the fragment.