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 requiring the use of a back brace, and positive results are not guaranteed. Risks from spinal fusion 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 Social Security’s listed impairments found in the “blue book.” In its section on Disorders of the Spine, the blue book lists several impairments which, if met, will automatically qualify a person for disability benefits.

Although you will not meet a listing simply by undergoing a spinal fusion procedure, it is possible that you could meet a listing for your underlying back problem or that you will meet a listing after receiving an unsuccessful spinal fusion.

The blue book listing on spinal disorders requires that:

• You have a disorder of the spine, such as spinal stenosis, degenerative disc disease, facet arthritis, osteoarthritis, or vertebral fracture, and
• The disorder causes compromise of a nerve root or the spinal cord.

In addition, you must demonstrate that you suffer from at least one of the following.

• Compression of the spinal nerve root, accompanied by pain and limited range of motion in the spine, muscle weakness, and sensory and reflex loss, or
• Inflammation of the spinal arachnoid, one of the membranes that protects the nerves of the spinal cord, causing severe pain or sensitivity in your back such that you need to change positions or postures more than once every two hours
• Narrowing of the spinal canal (stenosis), causing chronic pain, weakness, and a extreme limitation of the ability to walk.

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 is also likely to be accompanied by symptoms of intense pain, muscle weakness, and even paralysis.

If your spinal fusion did not repair your underlying back condition and you experience the symptoms listed above, you may meet a listing. However, 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. After deciding your condition doesn't meet a listing, Social Security will evaluate your condition based on the medical evidence in your case to determine your Residual Functional Capacity (RFC), which describes your ability to perform work-related activities despite your impairments. The main purpose of your RFC is to assess whether you can do sedentary, light, medium, or heavy work.

In making this assessment, Social Security will rely on the medical evidence and records in your case, which should 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 may also be useful in proving disability in cases involving spinal fusion.

In addition to your objective medical records, the opinion of your treating doctor is of paramount importance in demonstrating the severity of your condition. If your doctor is willing to complete an RFC form or write a statement about your condition, he or she should 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 are required 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 nonexertional limitations can restrict the type of potential jobs you could do.) Some discussion of medications you are taking and their side effects would also be helpful. Note that it is not necessary for your doctor to give an opinion as to whether you are “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 your remaining limitations that prevent you from performing work-related tasks.