Lumbar disc herniation and police officer

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lstudt

Lumbar disc herniation and police officer

Post by lstudt » Tue Aug 05, 2014 9:44 pm

We are seeing a 28 year old female police patrol officer. She has been on the job for 3 years. She required two separate lumbar diskectomies in 2005 and 2006, one level each. She experiences periodic back pain and/or radicular symptoms over the past 1-2 years requiring light duty for a few weeks and then return to full duty. The employer is asking about fit for duty, etc.

In reviewing the records, she has a new disc herniation at L4-5, which was operated on previously. She has no changes in her facet joints. Her exam reveals no deficits and conservative recommendations have been made.

The officer, her neurosurgeon, her PT all feel that if she were to have a vest for her gear instead of a duty belt, she would have less pain and less time on light duty. Her chief does not want to switch to a vest for fear of public perception of the police force being more "big city" in appearance.

In reviewing the limited literature, I cannot find anything that says the officer cannot work without restrictions if she is pain free. There are some recommendations for different types of belts (suspenders and vests) available. She is actively working with PT on her core, is very fit, and is doing everything else by the book.

I am leaning towards recommending a trial of the vest and seeing if her symptoms decrease, etc.

Any other thoughts? Thank you in advance for your comments.



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Re: Lumbar disc herniation and police officer

Post by Robert Swotinsky MD » Wed Aug 06, 2014 7:40 am

If there is severe stenosis per MRI, this person is likely unqualified from police work due to risk of further and severe injury from heavy activities at work. Reed's Disability Advisor suggests no need for restriction if mild or moderate stenosis and no neurologic abnormalities on exam.

I don't know that there is an evidence-based rationale to use, or not use, a vest v. gun belt. It sound more like an issue of tolerance and comfort, which are important, but the medical provider has no particular insight into necessity for one or the other.

markrainey

Re: Lumbar disc herniation and police officer

Post by markrainey » Thu Aug 14, 2014 4:03 pm

I agree that there is no evidence for a vest versus belt. If she prefers the vest, that is a reasonable, relatively harmless option. Repeated surgeries for lumbar disc problems in a young person is questionable.

lstudt

Re: Lumbar disc herniation and police officer

Post by lstudt » Wed Aug 20, 2014 11:49 am

I agree about the surgeries in a young person. I received the records and both surgeries seemed appropriate. Meaning, she exhausted all conservative measures prior to surgeries.

Thanks for your help.

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