Among neurological diseases vertebrogenic lesions of the peripheral nervous system occupy the first place in prevalence and temporary disability. The main cause of the prolonged, progressive course of the disease with the outcome of disability is spinal stenosis.
Examination of disability of the patient with spinal stenosis relies on the correct assessment of symptoms, formulation of a deployed functional diagnosis, in which, besides the etiological factors, type, prevalence of stenosis, necessarily indicate the nature of the disease and its severity. When determining the severity, we recommend using a 12-point scale, in which the severity of intermittent claudication, motor defect and pain syndrome is estimated at 4 points (4 points — mild, 3 — moderate, 2 — pronounced and 1 point — pronounced violations). Thus, the first degree of severity corresponds to 10-12 points, the second-8-9, the third-6-7, the fourth-1-5. The use of quantitative assessment of the severity of the disease, manifested by a complex symptom complex with a predominance of subjective complaints, pain syndrome (without tension symptoms), autonomic disorders, intermittent claudication, often with minimal neurological defect, can significantly improve the quality of medical examination.
Lesions of the spinal cord and its roots in patients with spinal canal stenosis are easily objectified by RVG, EMG, evoked potentials, thermography. Especially pronounced changes in performance after exercise walking and during the test with the extension of the spine, which confirms the subjective feelings of patients.
Acute episodes of cervicalgia, cervicobrachialgia, of thoracalgia, lumbalgia, sciatica, and transient paresis of the limbs in Association with minor trauma to the spine (neuropraxia) in the initial stage of the disease is reversible. Temporary disability in these cases is limited to 6-18 days. In patients with chronic, recurrent course, severe pain and intermittent claudication sick leave in exacerbations issued for 1-2 months. The disease of 3-4 severity (radicular syndrome, compression syndrome of the horse’s tail, myelopathy) is accompanied by temporary disability up to 3 months. At this time, patients receive a full range of conservative therapy (including HBO, glucocorticoids, calcitonin, vasoactive drugs, physiotherapy).
Temporary employment through VCC can prevent the progression of the disease, gives the opportunity to retrain patients, the acquisition of professions that exclude long walking, staying in a forced position on the legs or sitting, static and dynamic overload of the spine, sudden temperature changes, high humidity, vibration. If the transfer to another job is associated with the loss of qualification, the III group of disability is determined. Group II disability is established in patients with severe pain syndrome, severe intermittent claudication, paresis of hands or feet after a full course of adequate conservative therapy for 4-6 months in the absence of a tendency to regression of symptoms. Patients with deep paresis of the limbs, with intermittent claudication of the fourth degree of severity, immobilizing postural pain in spondylolisthesis (even in the absence of pronounced symptoms of prolapse), in need of constant outside care, are assigned to group I disability.
Most patients with spinal canal stenosis who have a disability group can expect full or partial rehabilitation as a result of surgery. This is true even for long-term and seriously ill people, patients over 60 years. Patients who do not have disability, after the operation is issued a sick leave for 2-3 months. In the future, the patient can be employed on a permanent basis without contraindicated occupational hazards. In the case of partial loss or reduction of skills, restrictions of production activity is determined by the III group, and patients with persistent motor defect or severe permanent pain syndrome – II group of disability.
Therefore, the complex of medical-preventive and rehabilitation procedures, which includes early diagnosis, proper professional orientation, the development of a certain life stereotype, carrying out appropriate medical, physical, orthopedic treatment, correction of instability, posture, helps to restore and long-term preservation of working capacity, provides a full life for many people with a narrow spinal canal. Timely properly planned and skillfully performed surgery can prevent disability of patients with progredient forms of the disease.