If you have a spine disorder that limits movement or causes chronic back pain, Social Security disability benefits may be available. To determine whether you are disabled by your back pain, or other spinal problems, the Social Security Administration first considers whether your back problems are severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. If you meet or equal a listing because of back pain or other spine disorders, you are considered disabled. If your back problems are not severe enough to equal or meet a listing, Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your back), to determine whether you qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process.
Impairments Causing Back Pain and Spine Immobility
Allegations of disability based on “back pain” are extremely common. Back pain and movement problems may be caused by a number of disorders including:
Some people may have structural problems in the spine that limit function (i.e., walking, bending, stooping, etc.). But question of disability usually depends on how much your chronic pain interferes with your ability to function (i.e., walk, bend, stoop, twist, lift, etc.). The great majority of individuals, more than 80%, who have acute low back pain from a strain of the ligaments and other soft-tissue supportive structures of the spine will recover within several months, even if they receive no treatment. Other individuals have a more chronic problem.
Spine Anatomy
The spine (vertebral column) has:
Figure 1: The human spine.
The spine provides structural support for the body and protects the spinal cord. Thirty-one pairs of nerve roots exit the spinal cord to form the peripheral nerves to the rest of the body. The peripheral nerves are sensory (carrying sensation), and motor (causing muscle movement). Disease processes affecting the spine can damage peripheral nerves at or near their origin (nerve roots), as well as the spinal cord itself.
Assessing Back Pain
The severity of back pain cannot be deduced solely based on abnormalities that are seen on plain X-rays, computerized tomography (CT), or magnetic resonance imaging (MRI) of the spine. Many people with significant degenerative abnormalities on X-ray have minimal or no symptoms, while some people who allege incapacitating back pain have minimal objective abnormalities. Nevertheless, even taking individual differences into account, there is a general correlation between objective abnormalities and credible pain.
The Social Security Administration will weigh your objective abnormalities, your reported pain and other symptoms, and your credibility in determining the severity of your impairment. In addition to objective evidence, your credibility with the Social Security Administration is strongly influenced by your behavior in seeking relief of alleged symptoms, your activities that are limited by pain, the nature and frequency of your visits to a doctor for treatment, your response to treatment given, and comments about your credibility in the treating doctor’s records.
Psychological and Social Factors in Back Pain
Although psychosocial factors play a major role in the functional loss caused by low back pain, there is no good way for the Social Security Administration to evaluate these factors. Psychosocial factors strongly predict future disability and the use of health care services for low back pain. Chronic disabling low back pain develops more frequently in patients who, at the initial evaluation for low back pain, have:
These psychosocial factors are particularly prevalent in persons with low back pain for whom imaging shows only degenerative changes; 70 to 80 percent of such patients demonstrate psychological distress on psychometric testing or have disputed compensation issues, compared with 20 to 30 percent of patients whose imaging studies reveal definite pathologic or destructive processes. These psychosocial factors should be routinely assessed in patients with low back pain and taken into account in decisions regarding treatment.
Osteoarthritis (OA)
Some degree of osteoarthritis of the spine is common in middle-aged people, even if they are not aware of it. OA of the spine can take several forms. In ankylosis, parts of the spine are abnormally fused together as a result of bony overgrowth. For example, bony spurs can fuse vertebral bodies together. The peripheral nerves formed from the spinal cord exit the bony spine through recesses in vertebrae called intervertebral foramina (see Figure 2 below). Some of these foramina can become encroached by osteoarthritis and require surgical decompression. Vertebrae have contact points with other vertebra called facet joints (see Figure 3 below).Arthritis affecting these facet joints can be painful and limit the motion of the spine.
Figure 2: Spinal cord and nerve roots.
Figure 3: Normal spinal canal with facet joints.
Degenerative Disc Disease (DDD)
Degenerative disc disease refers to dehydration and shrinkage of the intervertebral discs that cushion the vertebral bodies of the spine. DDD is common and causes no symptoms in many older individuals. Everyone over about the age of 50 has some degree of DDD, which may or may not be symptomatic and functionally limiting. Osteoarthritis of the spine is frequently accompanied by DDD, while DDD without associated OA is also common. DDD can be seen on X-rays, MRI, and CT scans of the spine. It appears as narrowing of the space between vertebral bodies. Symptomatic DDD occurs between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1).
Sometimes a combination of OA and DDD produces enough symptoms that surgical fusion is performed in the lumbar spine (lumbar fusion) or cervical spine (neck). This procedure is done in an attempt to stabilize the spine and decrease pain. The surgery requires taking strips of bone from the posterior (back) upper part of the pelvic bone and laying them over the vertebral bodies that need to be stabilized (see Figure 4 below). Bone is living tissue and will incorporate the vertebral bodies into one solid mass. Sometimes, the bone strips do not incorporate well and the surgical fusion partially or wholly fails. Some fusions involve only two vertebrae, but multiple vertebrae may also be fused.
Figure 4: Vertebral fusion using bone strips.
Herniated Nucleus Pulposus (HNP) or Herniated Disc
A herniated nucleus pulposus is the protrusion of the hard, cartilaginous center (nucleus) of an intervertebral disk through the outer fibrous tissue (annulus fibrosa) (see Figures 5 and 6 below). Many small HNPs will produce acute symptoms that improve with time. Injection of corticosteroid drugs in the area of the HNP can also help relieve inflammation and pain. Some claimants have a large HNP that presses on a spinal nerve root, and must have part of the HNP removed (discectomy, diskectomy).
Figure 5: An intervertebral disk with lateral herniation.