Strategies for Success: Common Work Related Spine Injuries

Dr. Matthew W Colman from Midwest Orthopaedics at Rush

Welcome To Athletico’sWebinar Wednesday Series

11/7/18

888 Work4U

Work Comp Customer Service Department• Prompt and efficient scheduling• Enhanced communication• Easy to locate the closest clinic offering

the service you need• Speak directly to an Athletico Work Comp

customer service representative • Call: 888-8-WORK4U• Email: Work4U@athletico.com• Visit: www.athletico.com/Work4U

Webinar Agenda

Today’s Webinar is from 8:30am to 9:30am CST

Agenda• 8:20 am - 8:30 am: Participants join call• 8:30 am: Host Introductions• 8:35 am: Presentation begins• 9:20 am: Q & A led by Heather Wilhelm, Athletico Account

Executive• 9:30 am: Closing Remarks/Poll

Participants

Within 48 hours after the webinar you will receive an email with links to download the following materials:

• 1.0 CEU for IL RN, CCMC, CRCC, Texas Dept. of Insurance• IA RN will be mailed out after the event

• A copy of the power point slides• If you have a question during the webinar you can enter your

question in the Q & A section at the bottom of the page. At the end of the webinar our moderator will pose these questions to DrColman.

• Please complete the survey at the end of the webinar in order to receive the link to get your CEU’s.

• Muted Lines/Operator Assisted Q & A

Today’s Speaker:Dr. Matthew W Colman

Orthopedic Oncology: Spine, Back and NeckAssistant Professor, Rush University Medical Center

Dr. Matthew Colman specializes in spine surgery and musculoskeletal oncology.

Dr. Colman completed his undergraduate training cum laude with honors from Dartmouth College, earned his medical degree with honors from the University of Chicago Pritzker School of Medicine, Chicago, IL, and went on to complete his residency in orthopedic surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA.

He has been fellowship trained in pediatric and adult musculoskeletal oncology at Harvard University and orthopedic and neurosurgical spine surgery at the University of Utah.

Dr. Colman has an interest in treating bone and soft tissue tumors wherever they occur, including the spine. He also treats a comprehensive set of non-tumor-related spinal problems, including degenerative disease, deformity, and trauma.

He is a member of the American Academy of Orthopaedic Surgeons (AAOS), AOSpine, the North American Spine Society, and Alpha Omega Alpha, University of Chicago Chapter.

Wor

k In

jurie

sCommon and uncommon neck injuries in the

injured workerMatthew Colman, MD

Assistant Professor, Spine Surgery and Musculoskeletal OncologyRush University Medical Center

Wor

k In

jurie

sIncidence and Etiology

• Neck Pain in Workers is 27-48%

• 11-14% of workers limited in duties due to neck pain

• 14% of claimants have multiple episodes

Van Eerd Spine 2011

Wor

k In

jurie

sReview of Cervical Anatomy

Wor

k In

jurie

sCommon Problems are Common!

• Soft tissue injury

• HNP

• Fractures

Wor

k In

jurie

sSoft Tissue

• Cervical Sprain / Strain /Whiplash spectrum

• Myofascial-liagmentousoveruse

• Exacerbation of pre-existing degenerative disc disease / cervical stenosis

Wor

k In

jurie

sAcute Disc Herniation

Just “looks different” than degenerative stenosis

Results in a pain, weakness, numbness of the higher numbered root (C6 at C5/6)

ACDF / TDA / Posterior Foraminotomy

Wor

k In

jurie

s

• Many different varieties depending on the mechanism

• Separate the benign from the “unstable”

• Treatment ranges from collar to major surgery

Fractures

Wor

k In

jurie

sWhat about the uncommon and

difficult to diagnose?

• Occult or “hidden” fracture

• Spinal cord injuries

• Ligament-only injuries

• Vascular injuries

Wor

k In

jurie

s

46F s/p MVA at work

• Struck from behind while operating company vehicle

• Neck pain immediately, but much worse the following day

• No arm pain

Occult Fracture

Wor

k In

jurie

s

Wor

k In

jurie

s

Wor

k In

jurie

s

Wor

k In

jurie

sHistory and Physical Exam

• Denies pre-existing symptoms• Neurologically normal• Axial neck pain and bilateral trapezial pain

Wor

k In

jurie

sInitial Treatment

• Hard cervical collar for 6 weeks• 2 sessions of PT• NSAIDs, tramadol, gabapentin• Trigger point injections

….but after 6 months, persistent LEFT sided trapezial and periscapular pain…and still unable to work despite light duty release

Wor

k In

jurie

sInjury 6 months s/p injury

Wor

k In

jurie

s

LEFT RIGHT

9 months post injury

Wor

k In

jurie

sDislocations

• Unilateral– Less than 50%

slippage (sometimes none)

– Commonly missed

Wor

k In

jurie

sIncomplete Spinal Cord Injury

• Central cord syndrome• From a “pinch” to

the spinal cord, usually due to hyperextension

• Brown-SequardSyndrome• From a cord

hemisection, iesharp penetration

Wor

k In

jurie

sComplete Spinal Cord Injury

Wor

k In

jurie

sAnterior and Posterior Fusion

Wor

k In

jurie

sVascular Injury

• Uncommon but potentially fatal

• Suspected any time a fracture exits into the vertebral foramen

• CT Angiogram

• Luckily, most people have redundant blood supply!

Wor

k In

jurie

s

Pseudarthrosis

• Can be silent until the new injury

• 5% per level in ACDF

• Anterior pseudo usually fixed by going posterior

Accidents are not “accidental”: when the injured worker already had surgery

Wor

k In

jurie

s

Adjacent segment disease

• Accepted to occur around 2.5% per year following surgery

• Injuries can accelerate

• Fix by going anterior again

Accidents are not “accidental”: when the injured worker already had surgery

Wor

k In

jurie

s

Hardware fracture

• Unlikely to happen from trauma

• Likely due to non-healing of original surgery

• May not require treatment

Accidents are not “accidental”: when the injured worker already had surgery

Wor

k In

jurie

sCommon Treatment Algorithms

• Conservative Care• Physical therapy

Wor

k In

jurie

sCommon Treatment Algorithms

• Conservative Care• Physical therapy• NSAIDs

Wor

k In

jurie

sCommon Treatment Algorithms

• Conservative Care• Physical therapy• NSAIDs• Neuromodulatory agents

Wor

k In

jurie

sCommon Treatment Algorithms

• Conservative Care• Physical therapy• NSAIDs• Neuromodulatory agents• Epidural Injections

Wor

k In

jurie

sCommon Treatment Algorithms

• Anterior Surgery• Discectomy and Fusion• Corpectomy• Cervical Disc Replacement

Wor

k In

jurie

sAnterior Cervical Discetomy / Fusion

Wor

k In

jurie

sACDF vs. CDR

• Most studies show equivalence or superiority in favor of CDR

• Neurologic recovery• Reoperation rate• Motion• Narcotic use

BUT…….

Wor

k In

jurie

sAcute on Chronic Arthritis with

Myelopathy

Wor

k In

jurie

sAnterior Corpectomy and Fusion

Wor

k In

jurie

sCommon Treatment Algorithms

• Posterior Surgery• Foraminotomy• Laminoplasty• Laminectomy and Fusion

Wor

k In

jurie

sAcute on Chronic Arthritis with

Myelopathy

Wor

k In

jurie

sPosterior Laminectomy and Fusion

Wor

k In

jurie

sOutcomes

Wor

k In

jurie

s

• WC vs Personal Injury Claimants

• WC with cervical disc herniation had significantly more lost days

Outcomes

Wor

k In

jurie

sOutcomes

• Poor Outcomes In WC patients?

• WC one of two independent predictors of poor outcomes

Wor

k In

jurie

sOutcomes

• Poor Outcomes In WC patients?

• But others show no difference in outcomes in carefully selected patients!

Wor

k In

jurie

sOutcomes

• CDR vs. ACDF in WC patients?

• No difference after 6 months, but more early return to work in CDR population

Wor

k In

jurie

sOutcomes

• Whiplash Injury in WC patients?

• Consulting a lawyer was an independent predictor of prolonged recovery!

Wor

k In

jurie

sSummary

• Most neck injuries at work can be treated without surgery

• Common conditions include herniated disc, sprain/strain, and minor fractures

• Uncommon diagnoses can be severe and require a high index of suspicion to properly diagnose and manage

• Surgical outcomes can be excellent for workman’s compensation patients when imaging and symptoms correlate, and sources of secondary gain are elucidated

Wor

k In

jurie

sThank You!

Thank you for joining us…

You will be receiving an email within approximately 48 hours with the below link. You will need to complete the survey and at the end of the survey it will take you to a link to retrieve your CEU’s (be sure

to say “yes” when it takes you to the trusted site or you will not receive your CEU’s).

https://www.surveymonkey.com/r/110718webinar