Spinal Fusion and Disability Benefits

Spinal fusion surgery (also called "arthrodesis") is often recommended for people suffering from broken vertebrae, spinal weakness, spinal deformities, and chronic lower back pain. Other conditions that cause instability in the spine, such as degenerative disk disease, arthritis, or scoliosis, can require spinal fusions as well.

As the name suggests, spinal fusion surgery involves fusing together two or more spinal vertebrae using bone graft material with rods, plates, or screws to hold the vertebrae and graft in place. As the bone graft heals, the vertebrae become permanently connected and immobilized.

A successful spinal fusion surgery can improve spinal stability and relieve chronic back pain. But a spinal fusion procedure typically requires many months of recovery, frequently with a back brace, and positive results are not guaranteed. Risks from spinal fusion surgery include spinal cord damage, graft rejection, increased back pain, and infection.

Does Spinal Fusion Qualify Me for Disability Benefits?

One of the easiest ways to be approved for Social Security disability benefits is for your condition to qualify under one of the listed impairments found in the Social Security Administration's "blue book." In its section on musculoskeletal disorders, the blue book lists several impairments which, if met, will automatically qualify a person for disability benefits, provided that they also meet the technical requirements of SSDI or SSI.

Although you won't meet a listing simply by undergoing a spinal fusion procedure, it's possible that you could meet a listing for your underlying back problem that caused the need for the fusion or that you'll meet a listing after going through an unsuccessful spinal fusion.

Meeting One of Social Security's Impairment Listings

The blue book listings for the spine require that:

• You have a disorder of the spine, such as spinal stenosis, degenerative disc disease, facet arthritis, osteoarthritis, herniated disc, or vertebral fracture, and
• The disorder causes compromise of a nerve root, cauda equina (the bundle of nerve roots at the lower end of the spinal cord), or the spinal cord itself.

Compromise of a nerve root. To qualify under listing 1.15 for "disorders of the skeletal spine resulting in compromise of a nerve root," you must demonstrate that you suffer from ALL of the following:

• radiating pain, paresthesia (prickling or "pins and needles" sensation), or muscle fatigue consistent with the compromise of the affected nerve root
• neurological signs during physical examination or testing, specifically (1) muscle weakness; (2) signs of nerve root irritation, tension, or compression; and (3) either sensory changes (such as decreased sensation or sensory nerve deficit on electrodiagnostic testing) or decreased deep tendon reflexes
• imaging results consistent with compromise of a nerve root, and
• a documented need for an assistive device that requires the use of both hands (walker, bilateral canes or crutches, wheelchair), or a device that requires use of one hand (if you're unable to use the other hand for work-related activities), or the inability to use both hands for work-related activities.

A vertebral fracture with spinal cord injury would likely meet the above listing because it involves a serious spinal disorder with spinal cord compromise. It's also likely to be accompanied by symptoms of intense pain, muscle weakness, and even paralysis.

Severe lumber stenosis. To qualify under listing 1.16 for "lumbar spinal stenosis resulting in compromise of the cauda equina," you must demonstrate that you suffer from ALL of the following:

• non-radiating pain in one or both legs. or non-radiating sensory loss in one or both legs, or neurogenic claudication (pain or cramping caused by nerve compression)
• neurological signs during physical examination or testing, specifically (1) muscle weakness, and (2) either sensory changes (such as decreased sensation, sensory nerve deficit on electrodiagnostic testing, traumatic ulcers, or bladder or bowel incontinence) or decreased deep tendon reflexes in one or both legs
• imaging results or notes in an operative report consistent with compromise of the cauda equina with lumbar spinal stenosis, and
• a documented need for an assistive device that requires the use of both hands (walker, bilateral canes or crutches, wheelchair), or a device that requires use of one hand (if you're unable to use the other hand for work-related activities).

If your spinal fusion didn't repair your underlying back condition and you experience the symptoms listed above, you may meet a listing. But meeting a listing in this category is very difficult, and only the most serious cases are likely to qualify.

Can I Qualify for Benefits Without Meeting a Listing?

It's not necessary to meet one of Social Security's blue book listings to be considered disabled. If the Social Security Administation (SSA) decides that your condition doesn't meet a listing, the agency will then evaluate your level of impairment. The SSA will use the medical evidence in your file to determine your "residual functional capacity" (RFC), which describes your ability to perform work-related activities. The main purpose of your RFC is to determine whether you can do sedentary, light, medium, or heavy work.

To create an accurate RFC for you, the SSA needs medical records that include physical examinations of your spine, range of motion tests, and observations from your physician about problems you experience related to your spine. X-rays, MRIs, and CT scans can also be useful in proving disability in cases involving spinal fusion.

In addition to your objective medical records, your doctor's opinion is very important to the SSA in determining the severity of your condition. If your doctor is willing to complete an RFC form or write a statement about your condition, ask them to offer specific opinions as to your physical limitations. For instance, your doctor should address the following questions:

• How long are you able to sit at one time?
• How long can you stand at one time?
• Are you able to bend, squat, and stoop?
• How much can you lift occasionally (up to one-third of an eight-hour workday)?
• How much can you lift frequently (up to two-thirds of an eight-hour workday)?

Your doctor should also address whether you need to use an assistive device for walking, whether you or must lie down or recline during the day, whether you must be able to switch between sitting or standing at will, and whether you must elevate your legs to relieve pain. (These "non-exertional" limitations can restrict the type of potential jobs you could do.)

It's also helpful for your doctor to include a discussion of medications you're taking and their side effects. Note that it's not necessary for your doctor to give an opinion as to whether you're "disabled," as that is a legal determination reserved for Social Security.

Social Security will determine, based on your RFC, whether you can do your prior job and whether there is some type of less demanding job you could do. In short, although you don't qualify for benefits simply by undergoing a spinal fusion procedure, you may qualify for benefits based on the remaining limitations that prevent you from performing work-related tasks.

Applying for Social Security Disability Due to Spinal Fusion

You can apply for Social Security disability in person at your local SSA office, by calling Social Security at 800-772-1213, or online at www.ssa.gov. To complete the disability application, you'll need detailed information, including the contact information and dates of treatment for all of your medical providers, the dates of any medical tests, and the names, addresses, and dates of employment for all of your employers in the last 15 years.

For more information, see our article on applying for SSDI benefits.

If you'd like help with your application, think about working with a legal professional. Click for a free case evaluation with an SSDI expert to determine whether your spinal condition is severe enough to qualify for benefits.