Back surgeries and spinal fusions can needed for many different reasons. Compression of spinal nerves caused by arthritis or scoliosis, degenerative disk disease, broken vertebrae, herniated disks, and any condition that causes spine instability may lead to the need for back surgery.
Types of Back Surgery That May Cause Disability
There are several different types of back surgery, with the most common type of surgery being spinal fusion. Here is a list of the various types of back surgery that can be performed:
- Spinal fusion, which is a surgery where two or more of the vertebrae in your spine are connected to become one solid piece.
- Diskectomy, which is the removal of part or all of a herniated disk.
- Laminectomy, which is removal of part of the bone that lies over the spinal canal.
- Vertebroplasty, which is the injection of bone cement into compressed vertebrae.
- Artificial disks, which is the placement of artificial disks in between two vertebrae. Placement of such disks is done as an alternative to spinal fusions.
Risks of Back Surgery or Spinal Fusion
There are risks that are associated with all back surgeries beyond the immediate risks that are present with any surgery done under anesthesia. Risks from back surgery include:
- Infection at the opening from the surgery or in the vertebrae bone itself.
- Damage to the spinal nerve, which can lead to limited range of motion in the spine, permanent loss of sensation, weakness and pain in the legs, and problems with the bowel and/or bladder.
- Instability in the spine when vertebrae are not fused together.
- Degeneration (wearing down) of the vertebrae above and below fusions.
Disability Benefits Following Back Surgery or Spinal Fusion
In order to receive Social Security Disability benefits, the condition of your back must match one of Social Security's disability listings for back problems or you must convince your claims examiner that your back problems limit your functioning so much that there are no jobs you can do.
Meeting a Disability Listing
There is no specific disability listing for back surgery or spinal fusion, but if the surgery did not correct your impairmentsyou might meet the requirements of a listing based on the ailments or impairments that led you to needing back surgery or spinal fusion.
Listing 1.04: Disorders of the Spine
If your back surgery or spinal fusion was not successful at restoring your back, you might qualify for benefits under this listing; the underlying causes for the need for most back surgeries are covered in this listing. To qualify as disabled under this listing, you must show that you have one of the following:
- Compression of the nerves in the spine that cause pain, muscle weakness, and movement in your legs
- Inflammation of the membrane that surrounds your spine that causes severe burning or pain in your back and requires you to change positions at least once every two hour, or
- Narrowing of the spinal canal that causes pain, weakness, and difficulty walking.
Another way to receive disability benefits is to "equal" a listing. Your condition will be considered medically equivalent to a listing if you can show that you have impairments that are similar in severity and duration to a similar impairment.
Listing 1.03: Reconstructive Surgery or Surgical Fusion of Weight-Bearing Joints
This disability listing applies to surgery or fusion on weight-bearing joints, which Social Security considers to be the hip, knees, shoulder, elbow, wrist/hand, and ankle/foot. To meet the requirements of this listing, you must show that you are unable to walk effectively and that a return to normal walking did not happen after the surgery, and it is not expected to happen for at least 12 months from when its onset.
The spine is specifically not included in this listing with the other major weight-bearing joints; however, the limitations on walking that can be caused by (or not corrected by) back surgeries are the same that can occur from injuries or surgeries to the major weight-bearing joints. Therefore, it's likely that your spinal fusion could equal this listing if it did not correct difficulties you have with walking and your difficulties are just as severe and will last as long those caused by injuries or surgeries to major weight-bearing joints. Other back surgeries, including the placement of artificial disks into the spine, may be considered reconstructive surgeries and could equal this listing as well.
Medical Evidence Required to Meet a Listing
The medical evidence that is required to get disability benefits for back problems or back surgery include detailed descriptions from physical examinations of the spine, descriptions of any problems with walking and limitations noted when asked to do tasks such as walking on your toes or heels, limitations in range of motion, and observations from the physician regarding any limitations seen while at the appointment (such as difficulty getting onto or off of the examination table).laboratory findings that include x-rays, MRIs, and CAT scans can be helpful.
Duration of Your Symptoms and Medical Records
Social Security will be looking for evidence that your disabling symptoms will last at least 12 months, if they have not already, but back impairments, especially following surgery or fusion, frequently improve over time and/or with treatment. Therefore, your medical record should cover the entire duration of your back impairments, including different treatments that were tried, when they were tried, and your body’s response to the different treatments.
Showing Your Functioning Is Limited
Many patients who apply for disability following back surgery will not meet or equal a listing, but still get disability by showing their functioning is so limited by their back problems that there is no work they can do.
RFC assessment. If you don't meet a listing, your Social Security claims examiner is required to evaluate your ability to do any type of work by assessing your Residual Functional Capacity (RFC). To do this, the examiner will look at your ability to do physical work, called exertional limitations, and the other abilities required to do work, called nonexertional limitations.
Exertional limitations. For those who have had back surgery, including spinal fusions, the physical activities associated with work may be difficult. If there is damage to the spinal nerve, you have limitations on range of motion in the spine, or you suffer from loss of sensation, weakness, or pain in the legs, you may be unable to lift, carry, or move items. These exertional limitations would make you unfit for heavy or medium work, but are not enough for you to qualify for disability benefits.
Nonexertional limitations.You must show that you have nonexertional limitations as well, such as an inability to concentrate enough to finish a task or sit at a desk for an extended period of time. Individuals who have had back surgery may have difficulty sitting in one position without discomfort or concentrating if they have residual pain in their back or legs. Additionally, bowel and bladder issues may also increase their need to use the bathroom, which would further interrupt their ability to complete tasks.
Less than sedentary work. If your exertional and nonexertional limitations combine to make it impossible for you to do heavy or medium work requiring lifting, as well as light or sedentary work requiring sitting and concentrating (sometimes called the ability to do "less than sedentary work"), you should be approved for disability. But this is not an easy test to pass -- for more information, see our article on less than sedentary work.
The job of a vocational expert. Social Security can almost always come up with a job that you can do. Your claims examiner may consult with a vocational analyst employed by Social Security to see if they can find any jobs that someone with your limitations can do (a favorite of examiners is "surveillance system monitor," since it takes little exertional or nonexertional capacity). If the examiner and analyst come up with any job you could do (while also taking into account your prior jobs skills, English-language skills, and education), you will be denied benefits. But if you (or more likely, your disability lawyer) can come up with reasons that you can't do each job raised by the vocational expert (this would happen at an appeal hearing), you could be granted a medical-vocational allowance.