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.

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.

I Have A Spinal Cord Injury Because Of A Work Injury. What Can Be Done To Help Me.

Spinal cord injury cases can involve significant costly damages both medically and monetarily. It is extremely important that the injured party receive proper representation by an experienced workers compensation attorney familiar with these injuries. In the past Atkinson Law Offices and Minnesota Disability have represented individuals with serious spinal cord injuries including quadriplegic spinal cord injuries.

In serious accidents the spinal cord can be damaged, anywhere from the neck down through the lower back. The spinal cord is designed to transmit both feeling and control between the brain and the rest of our body. If a traumatic event damages the spinal cord, communication between the brain and other parts of the body can be cut off, resulting in varying levels of paralysis and loss of function. These injuries can be devastating to the injured party and his or her loved ones.

Spinal cord injuries fall into two category types, complete and incomplete. A complete injury is associated with the total loss of function below the level of injury. In such cases there is no sensation, nor voluntary movement below the level of injury. An incomplete injury is characterized by partial function below the level of injury. An individual suffering from incomplete paralysis can experience an array of symptoms including partial voluntary control, feeling in areas that cannot be controlled voluntarily, or the ability to control one side of the body and not the other.

How an individual’s body is affected by a spinal cord injury is generally dependent on the level of injury. Typically, the higher up a spinal injury occurs, the more widespread the effect on the body. Usually, cervical (neck) injuries result in quadriplegia, involving loss of function in both the upper and lower extremities. Injuries above the C-4 vertebrae may even require use of a ventilator to assist with breathing. C-5 injuries can result in retention of shoulder and upper arm control, but a lack of control in the lower arm and hands. C-7 injuries usually allow some level of control in the hand and fingers despite problems with dexterity.

Lower level spinal damage that occurs in the thoracic level and below can result in paraplegia. Paraplegia is generally associated with the loss of use of the legs. However, paraplegia can also result in a myriad of other conditions including: poor muscle control in the trunk, dysfunction of the bowel and bladder, sexual dysfunction, blood pressure problems, inability to properly regulate body temperature, and chronic pain.

Finally, spinal cord injuries can result as a consequence to admitted cervical thoracic and lumbar back injuries. Occasionally during surgery damage can result to he cord or main nerves. The resulting damage is also considered a work injury as long as the underlying treatment is work related. If you sustain a work related spinal cord injury, attorney Thomas Atkinson is ready to assist you provide you with advice and recommendations to assist you with your recovery. Workers compensation benefits including nursing services, reimbursement for family care, home remodeling and other benefits are reimbursable under Minnesota’s Workers Compensation statute. Contact Tom at 651-3224-9514 or tom@mndisability.com You can also visit his website at www.mndisability.com

GET PROMPT MEDICAL TREATMENT WITH PROVIDER OF YOUR CHOICE

An employee is entitled to payment of medical, psychological, chiropractic, and other treatment for a work-related condition. Minn. Stat. §176.135. This includes any treatment which is reasonable and necessary to cure and relieve the effects of a work injury.

Almost without exception, the injured worker has the absolute right to choose his or her treating doctor for a work injury. The employee can change doctors within 60 days after medical treatment has commenced, without getting the permission of the employer, insurer, or other interested parties. Minn. Rule Part 5221.0430, Subpart 2. After 60 days, the employee can change primary doctors, but only with the permission of the employer and insurer, or by seeking approval of the court. The rule provides that the employee may not change primary doctors if:

(a) A significant reason for the request is to block reasonable treatment or to avoid returning to work;

(b) The change is to develop litigation strategy rather than to pursue appropriate diagnosis and treatment;

(c) The provider lacks the expertise to treat the employee for the injury;

(d) The travel distance to obtain treatment is an unnecessary expense and the same care is available at a more reasonable location;

(e) At the time of the employee's request, no further treatment is needed; or

(f) For another reason, the request is not in the best interest of the employee and the employer.

In other words, even if the employee's initial treatment is at an emergency room or at an occupational medicine clinic favored by the employer, the employee can change doctors within 60 days. Choosing a qualified physician is important. A general orthopedic surgeon may not be you physician of choice if you have a complex hand injury. There are specialties within specialties and attorney Thomas Atkinson with Minnesota Disability can help you sort through this complex system.

Back & Neck Pain - Part II

Facet Joints

Lumbar facet joint are small pairs of joints on the back side of the spine where the vertebrae meet. These joints provide stability to the spine by interlocking two adjacent vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist.

Inflammation of facet joints can occur from injuries or from arthritis. Many times, particularly in the case of injuries, one may not see abnormalities on an x-ray or MRI.

Spinal Stenosis
The term lumbar stenosis refers to any narrowing of the spinal canal. There are many causes of spinal stenosis; the most common is degeneration of the spine, which occurs almost inevitably as a part of the aging process.

Several factors contribute to the narrowing of the spinal canal with degenerative changes. First, wear and tear causes the facet joint to enlarge into the spinal canal. Second, the major ligament of the spinal canal, the ligamentum flavum, undergoes hypertrophy (enlargement) and buckling. Third, the intervertebral discs may bulge backwards or herniate into the canal. Fourth, the vertebrae may slip forward in a condition called spondylolisthesis. Finally, these changes may be superimposed on a congenitally narrow canal.

The hallmark of lumbar stenosis is pain in the back and legs which is aggravated by standing and walking and relieved by sitting or forward bending. The syndrome of pain induced by walking is known as neurogenic claudication (from the Latin claudico, to limp). Neurogenic claudication must be distinguished from is vascular claudication, or leg pain on walking caused by insufficient blood flow to the legs. The features which help to distinguish neurogenic from vascular claudication are the following:

1. Pain occurs after varying amounts of exercise, with standing, or with coughing. Vascular claudication is reliably produced with a fixed amount of exercise, such as walking a certain number of blocks, and is rare at rest.
2. Pain relief with rest is variable and slow, usually requiring sitting or stooping. Resting in a standing position is usually not enough to relieve the pain and may even aggravate the pain. In contrast, the pain of vascular insufficiency is usually quickly relieved by resting in a standing position. This is the main distinguishing feature.
3. Pain from spinal stenosis is usually in a distribution of a spinal nerve rather than the muscles exercised.
4. Sensory loss is also in a nerve root distribution, while with vascular insufficiency it is in a stocking-glove distribution.
5. Signs of vascular insufficiency should be absent: diminished pulses, foot pallor on elevation, and decreased temperature of the feet.

Spondylolysis and Spondylolisthesis
The most common cause of low back pain in adolescent athletes is a stress fracture in one of the vertebrae that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects either the fourth or the fifth lumbar vertebra in the lower back. The fracture site is called a pars defect.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the top vertebrae can shift forward on top of the bottom vertebrae. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis).

In adults, a spondylolisthesis is usually caused from degenerative changes in the spine. If too much slippage occurs, the bones may begin to press on nerves and surgery may become necessary to correct the condition.

Causes

• Genetics: There may be an inherited aspect to spondylolysis. An individual may be born with a thin vertebral bone and therefore may be predisposed to this condition. Rapid growth spurts in a teen may also encourage slippage.
• Overuse: Several types of athletics, such as gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. They also require that the individual constantly over-stretch (hyperextend) the spine. In either case, the excessive stress can lead to fractures of the vertebrae.
• Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.

Sacroiliac Joints
The sacroiliac joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint:

1. Transmits all the forces of the upper body to the pelvis (hips) and legs
2. Acts as a shock-absorbing structure
3. Does not have much motion

The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities such as undue stress on the joint following low back fusion surgery. Pain from sacroiliac joint abnormalities can occur in the low back, buttock/hip, abdomen, groin, or legs.

Ankylosing Spondylitis
Ankylosing spondylitis primarily affects the spine or back. In a person with ankylosing spondylitis, the joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Other joints such as the hips, shoulders, knees, or ankles also may become involved.

Other rare causes of back pain include:

• Benign or malignant tumors
• Infections
• Problems of the digestive tract or genitourinary tract
• Vascular problems such as an aneurysm or hardening of the arteries

Back & Neck Pain - Part I

Causes of back pain

Muscles/Ligaments

There are many causes of back pain, the most common of which is a sprain or strain of muscles or ligaments. Muscle spasm can occur after twisting or bending awkwardly, or from a simple sneeze or cough. The majority of muscle spasms tend to get better over time. Severe cases of muscle spasms are treated with medication, physical therapy, or injections.

Discs

Disc Degeneration
Disc problems are common causes of back pain. Discs are usually moist, like a sponge with water in it. After a disc injury, or as we age, discs lose water and deteriorate in a process called disc degeneration.

The earliest form of injury to a disc is in the form of tears or fissures in the annulus fibrosis (outer portion) of the disc. The annulus fibrosis is like a large round ligament that prevents the nucleus pulposus (inner portion) of the disc from pushing outward. Tears in the annulus heal by scar formation resulting in tissue that is not as strong as normal tissue. The repeated cycle of many annular tears healing by scar formation lead to a disc that begins to degenerate.

As a disc degenerates it becomes stiff, narrows, and losses it's ability to act as a shock absorber. Bone from the vertebrae above and below the disc may grow forming bone spurs. If bone spurs get large enough, they may cause pressure on nerves in the spinal canal, causing pain, numbness, and weakness in the arms or legs. The combination of disc degeneration and bone spur formation in the spine is called spondylosis. Any narrowing within the spinal canal, from bone spur formation or from any other cause is called spinal stenosis. Spondylosis or spinal stenosis can occur at any level in the spine-cervical, thoracic, or lumbar.

Bulging Disc, Protruding Disc, Herniated Disc, Extruded disc
Over time, because of injury or degeneration, discs start to change shape. Many terms describe this change in shape including bulging, protruding, herniated, prolapsed, slipped. They generally describe a disc that is displaced beyond the limits of the intervertebral disc space.

The earliest change in shape many times is in the form of a disc bulge-a wide based extension of the disc. Often, disc bulges do not cause pain. As the degenerative process progresses, the central, nucleus pulposus portion of the disc can extend through a tear in the outer annular wall of the disc, resulting in a focal protrusion or herniation of the disc. Disc protrusions can cause symptoms of pain, numbness, or weakness from nerve root pinching. In some individuals however, disc protrusions will not cause any symptoms. A disc extrusion is a severe version of a disc protrusion in which a large portion of the nucleus pulposus is displaced through the wall of the disc. A disc extrusion is almost always symptomatic.