Code of Colorado Regulations
1100 - Department of Labor and Employment
1101 - Division of Workers' Compensation
7 CCR 1101-3 R17 Ex 08 - Rule 17, Exhibit 8 - CERVICAL SPINE INJURY MEDICAL TREATMENT GUIDELINES
Section 7 CCR 1101-3-17-08-3 - Overview of Care

Current through Register Vol. 47, No. 17, September 10, 2024

Introduction. Neck pain is a common condition in the adult population. Neck pain in the working population most commonly occurs from cervical strain injuries, whiplash associated disorder, or degenerative conditions aggravated by work. Most individuals with neck pain without neurological findings will recover with therapy and self-management without invasive measures. These guidelines outline a biopsychosocial approach to neck pain care and integrate biological, psychological, and social elements.

Significant trauma resulting in fractures and/or spinal cord dysfunction are not covered in these guidelines. Early imaging and surgical evaluation should be reserved for more severe issues outlined in recommendation 1. Most patients will respond to conservative care as outlined in recommendations 2 through 5 and will not require invasive treatment. Additional interventions, as indicated for less common cases, are covered by the remaining recommendations. Refer to the Mild Traumatic Brain Injury Medical Treatment Guidelines (MTGs) for information on cervicogenic headache.

Recommendations.

Core Requirements.

Recommendation 1. Early imaging and surgical evaluation is required for patients with signs of myelopathy, progressive neurologic deficits, upper extremity weakness, or epidural abscess.

Recommendation 2. Initial conservative management without imaging is strongly recommended for neck pain patients who do not meet the criteria in recommendation 1, focusing on the following:

* education that prolonged periods of immobility are detrimental,

* education on the positive impact of movement on recovery,

* appropriate use of over the counter medications, and

* application of ice or heat.

Recommendation 3. Cervical immobilization as the sole treatment is not recommended for nonspecific neck pain when there is no clinical concern for instability.

Recommendation 4. Close follow-up and subsequent neurologic examinations are required for patients with radicular neck pain who do not meet the criteria in recommendation 1 or recommendation 8.

Recommendation 5. Participation in self-directed exercise or an active therapy program that includes core stabilization, strengthening, and endurance is recommended as a principal neck pain treatment. See the Active Therapies section.

Recommendation 6. Individuals with barriers to functional recovery may benefit from an interdisciplinary approach to care. See the Diagnosis section.

Recommendation 7. Referral for epidural steroid injection (ESI) evaluation within 6 weeks of pain onset is permitted when all of the following criteria are met:

* function-limiting pain in arms greater than the neck that interferes with return to work, activities of daily living (ADLs), and/or participation in active therapy; and

* positive correlation among clinical findings, the clinical course, and diagnostic tests.

See the Epidural Steroid Injection section.

Recommendation 8. Referral for discectomy evaluation within 6 weeks of pain onset is permitted when all of the following criteria are met:

* function-limiting pain in arms greater than the neck that interferes with return to work, ADLs,

and/or participation in active therapy;

* physical exam findings of abnormal reflexes, motor weakness, or radicular sensory deficits;

* findings on magnetic resonance imaging (MRI) indicate impingement of nerves or the spinal cord corresponding to reproducible physical exam findings; and

* the observed pathology is amenable to surgical intervention.

See the Discectomy section.

Recommendation 9. Referral for spinal injection is indicated when all of the following criteria are met:

* positive correlation among clinical findings, the clinical course, and diagnostic tests;

* positive functional response to a diagnostic injection, if required;

* persistent functional impairment despite engagement in 6 weeks of active therapy; and confounding psychosocial risk factors have been screened for and clinically addressed. See the Behavioral and Psychological Interventions section.

See the Injections section.

Recommendation 10. Referral of patients with cervical radiculopathy for surgical evaluation is recommended when confirmatory imaging studies specifically correlate with clinical findings, demonstrating nerve root compression or spinal cord compromise, and any of the following are present:

* acute, incapacitating pain with progressive neurologic deficits;

* persistent or recurrent arm pain with functional limitations unresponsive to 6 weeks of treatment;

* progressive neurologic deficits; or

* static neurologic deficit with significant radicular pain.

Evidence Tables. See related sections for evidence tables.

Disclaimer: These regulations may not be the most recent version. Colorado may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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