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ID: IC Plans Six Public Meetings to Explain Fee Schedule Changes.

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The cervical (neck) spine is the most flexible part of the vertebral column and has the least protection. Generally, however, the cervical spinal canal is at least 30 percent larger in diameter than the cord within it, allowing most patients to sustain a fair amount of dislocation without damage to the cord.

By contrast, the thoracic (in the chest area) spine is strongly fixed to the ribs and much less flexible, requiring a great deal of force to dislocate it, and the thoracic canal is not much larger in diameter than the cord.

CAUSES OF INJURY

Falls in the Workplace. Important causes of spinal cord injury in the workplace are falls, motor vehicle accidents, being hit by falling objects, explosions and crush injuries. The most frequent cause of occupational spinal cord injury is falls, which, in a Colorado study, were found to cause 50 percent of all occupational spinal cord injuries; in a Texas study, falls comprised 44 percent of all such injuries. Being hit by a falling object caused 18.9 percent of injuries.

Construction Industry. Falls were particularly likely to occur in the construction industry, with its risk of falling from one level to a lower one. In fact, 41.9 percent of occupational spinal cord injuries happened to workers in this industry. This is consistent with the fact that the construction industry has the highest overall injury rate of all sectors. Other than falls, hazards in this industry include collapse of structures and trenches, and proximity to large machines, such as earth movers, that can back up and hit workers on the ground or tip over and crush the driver.

Motor Vehicle Accidents. By contrast with the 50 percent figure for nonoccupational spinal cord injury, motor vehicle accidents comprised only 18.9 percent of occupational cases in Colorado. These accidents occurred when the victims were delivering products or services or driving between work sites. Occupational motor vehicle accidents also occur at shipping and receiving departments, in parking lots, on roadways around factories and railroad sidings, and in the operation of trucks, tractor-trailers and earth-moving equipment.

Other Causes. Other causes of occupational spinal cord injury in Colorado were skiing, gunshot wounds and stabbings. The occupations of the victims included professional/ managerial, clerical/sales, service, farming, fishing, forestry, processing and bench work, in addition to construction. Injury rates in the manufacturing sector are high (though not as high as in construction), due to risks such as contact with moving machinery, crane loads striking workers, falls from trestles or ladders, explosions of gases, vapors or other inflammable substances, and falling objects.

PREVENTION OF INJURY

Injury Control Programs. Prevention of spinal cord injury in the workplace requires incorporation of injury controls into the design of plants and equipment. Industrial hygiene involves recognition of occupational hazards, then taking measures to control them. This is often achieved through a formal occupational safety program concerned with preventing accidents. Important components of such a program include the following:

• a safety committee whose members come from the entire work force;
• the presence of emergency medical facilities on site;
• an inspection program designed to recognize hazards in the worksite (frequently this is made a responsibility of the safety committee); and
• investigations carried out following accidents for the purpose of developing measures to prevent recurrence, observing patterns of work flow, environmental conditions, and levels of stress to which workers are subject.

Recognition of Hazards. The best method for recognizing materials and processes that may result in harm to workers is to carry out inspections of the workplace. Safety engineers have developed models of "good practice" to prevent injury. Examples would be proper construction of scaffolding and use of ladders that conform to codes on construction sites. During a "walk-through survey," therefore, safety committee members would observe whether actual work practices conform to the model, as well as the effectiveness of control measures. They would also inspect equipment.

Control of Hazards. Control of workplace hazards includes controls on human behavior as well as preventive maintenance of equipment such as motor vehicles. One type of control on behavior is administrative controls, such as creating safe pathways through the workplace, scheduling dangerous operations at times when the fewest number of workers are present and forbidding individuals without proper training to enter such a worksite.

Another important element of hazard control is educating workers to understand hazards and training them in safe operating practices. Occupational Health and Safety Administration standards mandate specialized training programs for workers who operate particular types of equipment, such as forklifts, cranes or powered punch presses.

Control of work practices may require continuous supervision. In the case of workers who will operate vehicles, the safety program may include screening of workers or job applicants and ongoing medical surveillance.

© Copyright 2011 LexisNexis. All rights reserved. This article was excerpted from Occupational Injuries and Illnesses, Ch. 18, Spinal Cord and Nerve Root Injuries.