Disability Benefits for Spinal Fusion or Back Surgery

Back surgery, such as spinal fusion, is often recommended to treat the compression of spinal nerves caused by arthritis, scoliosis, degenerative disc disease, or herniated discs. Spinal fusion can also stabilize the back for people with conditions that cause spine instability, like fractured vertebrae (“back bones”), lumbar spondylolisthesis (slipped vertebrae), or tumors.

If you have permanent restrictions after a spinal fusion or a back surgery that keep you from working full-time for at least 12 months, you may qualify for Social Security disability benefits (SSDI or SSI). Before you apply, it’s a good idea to learn some basics about the disability determination process and what evidence you’ll need to provide to make your claim as strong as possible.

What Types of Back Surgery Qualify for Disability?

While the majority of back surgeries are successful, certain kinds of common back surgeries can cause disabling limitations. Some of the most frequent surgeries seen by Social Security disability claims examiners and administrative law judges include:

• spinal fusion, where two or more of the vertebrae in your spine are connected to become one solid piece
• discectomy or laminectomy, where part of the herniated disc that is pressing on your spinal cord is removed or reshaped, and
• disc replacement, which involves putting an artificial disc in between two vertebrae.

Keep in mind that the Social Security Administration (SSA) is more concerned with any functional limitations you have as a result of your back surgery than the specific kind of surgery you had. Somebody who recovered from a laminectomy with minimal limitations is less likely to qualify for disability than somebody who is unable to sit for 30 minutes following an unsuccessful spinal fusion.

How to Get Disability Benefits for Back Surgery or Spinal Fusion

You can get disability benefits if you have medical evidence that matches one of the SSA’s Blue Book listings for back disorders (called “meeting a listed impairment”) or if your back problems limit your functioning so much that no jobs exist that you can do (called getting a “medical-vocational allowance”). Let’s have a look at what these methods entail.

Getting Disability by Meeting a Listing for Spinal Impairments

Listed impairments are medical conditions that the SSA considers especially serious. If you meet a listing, you’ll be awarded disability benefits automatically, without having to show that no jobs exist that you can perform.

While the agency doesn’t have a specific disability listing for back surgery or spinal fusion, if your surgery didn't improve your symptoms, you might meet the requirements of a listing based on the initial problem that made surgery necessary. Or, if your surgery caused nerve compression, you might qualify for benefits under the listings for those conditions.

Social Security evaluates back impairments under the category for musculoskeletal disorders. Relevant listings for people with back problems include:

• listing 1.15, for compression of a spinal nerve root
• listing 1.16, for lumbar spinal stenosis compressing a nerve root known as the cauda equina, and
• listing 1.17, for surgical fusion of weight-bearing joints.

In order to meet these listings, you must have a documented medical need (usually meaning a prescription) for a mobility aid such as a walker, wheelchair, or crutches. Spinal cord conditions that aren’t covered by the above listings—such as arachnoiditis—are evaluated as neurological (nerve) disorders under listing 11.08.

Getting Disability by Showing Your Functioning Is Too Limited for Any Jobs

Many people who apply for disability following back surgery won’t have the right evidence to meet (or "equal") a listing. But you can still qualify for benefits if your residual functional capacity (RFC) rules out all full-time work. Your RFC is a set of restrictions that reflect the most you’re able to do, physically and mentally, at work.

Social Security will look at your medical records and your activities of daily living to determine what kinds of physical tasks you’d have difficulty performing in a work environment, such as walking, lifting, or carrying objects (“exertional limitations”). The agency will also review other difficulties you have in movements such as bending or kneeling, as well as mental limitations like trouble with concentration and focus. Both exertional and non-exertional limitations must be included in your RFC.

Once Social Security has assessed your limitations, the agency will look at your work history to see if you could do any of your old jobs given your current RFC. If your past work is too physically or mentally demanding for you to perform today, then the agency will need to determine whether any other jobs exist in significant numbers that you can do with your current RFC, given your age, education, and work experience.

Most disability applicants under 50 years old need to show that they can’t do even the easiest, least demanding jobs before Social Security can award them benefits. However, if you’re 50 years of age or older, you might be able to use the medical-vocational grid rules to qualify for benefits if you could physically perform lighter work but have never done it before (and can’t learn).

When Do I Know If My Back Surgery or Spinal Fusion Is Disabling?

Back surgeries are often used to relieve spinal stenosis or bone spurs. Some people experience a great deal of relief following these procedures, while others have mixed results and remain unable to work. If you underwent a laminectomy, discectomy, or spinal fusion and you still have significant functional limitations after one year that affect your ability to work, it may be time to file for disability benefits.

Back surgeries that don’t have the intended result of reducing back pain or improving mobility are called “failed back surgeries.” Sometimes referred to as post-discectomy or post-laminectomy syndrome (depending on the type of initial surgery), failed back surgeries can cause the following complications:

• infection at the opening from the surgery or in the vertebra itself
• instability in the spine when vertebrae are not fused together
• degeneration (wearing down) of the bones next to the fused bones
• spinal arachnoiditis (inflammation of a membrane that protects the nerves of the spinal cord)
• scar tissue that builds near a spinal nerve root (epidural fibrosis), or
• damage to the spinal nerve.

Symptoms of failed back surgery can include a reduced range of motion in the affected area of the spine; numbness, weakness, and pain in the legs and arms; and bladder or bowel incontinence. In order to help reduce these symptoms, doctors sometimes need to perform a revision surgery in order to fix what went wrong the first time. But if your symptoms persist despite a revision surgery, medication, and physical therapy, you may qualify for disability.

Medical Evidence You’ll Need to Get Disability for Spinal Fusion or Back Surgery

Your medical evidence is the foundation of your disability claim. Social Security needs to see documentation of the signs and symptoms that caused you to need back surgery in the first place, as well as the treatment you’ve received following your surgery. You should have the following evidence in your record to have your best shot at winning your disability claim:

• objective imaging, such as an X-ray, MRI, or CT scan, showing abnormalities in your spine
• doctor’s notes that include observations on any difficulties you have while at the appointment, like trouble getting off or onto the examination table
• results of a physical examination that indicate limitations in your range of motion
• admission and discharge notes from the hospital where you had your spinal fusion or back surgery
• tests such as a nerve conduction study showing latency (a measurement of how well your nerves are responding)
• a list of any medications you’re taking to help manage your symptoms, and
• notes from a physical therapist or rehabilitation specialist documenting your healing process.

You can also help increase your chances of a successful claim if you can provide a medical source statement from your doctor. The SSA values opinions of professionals who’ve treated you for your medical condition and can help shed light on your functional limitations.

How to Apply for Disability Benefits

Filing for Social Security is a fairly straightforward process. You can choose from the following methods:

• Apply online at the SSA’s website.
• Call the SSA at 800-722-1212 from 7 a.m. to 7 p.m. Monday through Friday. If you’re deaf or hard of hearing, you can call the TTY number at 800-325-0778.
• Visit your nearest Social Security field office and apply in person.

Keep in mind that Social Security runs two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each has its own preliminary non-medical eligibility requirements that must be met in order to legally receive benefits. For additional details, check out our step-by-step guide on applying for SSDI or SSI.

Getting Legal Help With Your Disability Claim

You aren’t required to get legal assistance during any part of the disability determination process, but it’s often a smart move—especially if your claim has been denied (as most are on the first try) and you need to schedule a disability hearing with an administrative law judge.

An experienced lawyer can help you gather the medical evidence you need to show that you’re disabled and can handle communications with Social Security so that you don’t miss any important appeal deadlines. Disability attorneys work on contingency (meaning they get paid only if you win) and many offer free consultations, so it doesn’t hurt to ask around to find a lawyer you like.