Workers’ Compensation Back Pain & Sciatica Treatment in Massachusetts

Specialized Evaluation and Treatment of Work-Related Back Injuries

A work-related back injury can cause persistent lower back pain, sciatica, and symptoms that interfere with your ability to work and perform everyday activities. These injuries may result from lifting, repetitive movements, falls, workplace accidents, or other physical demands.

Pat Bovonratwet, MD, is an orthopaedic spine surgeon at Massachusetts General Hospital (Mass General) who specializes in the evaluation and treatment of lumbar spine conditions, including work-related back injuries, herniated discs, spinal stenosis, and nerve compression.

Dr. Bovonratwet provides specialized spine consultations and treatment recommendations for patients with workers’ compensation injuries. Treatment options may include nonsurgical management, minimally invasive spine surgery, and endoscopic spine surgery when appropriate.

Common Work-Related Back Injuries

Work-related activities can contribute to several conditions affecting the lumbar spine. The appropriate treatment depends on the underlying injury, symptoms, physical examination, and imaging findings.

Lumbar Herniated Disc

A lumbar herniated disc occurs when the soft inner material of an intervertebral disc protrudes through its outer layer. This can irritate or compress nearby spinal nerves, causing lower back pain, leg pain, numbness, or weakness.

Herniated discs may occur following heavy lifting, repetitive bending, twisting, or workplace accidents.

Sciatica and Lumbar Radiculopathy

Sciatica describes pain that travels from the lower back into the buttock and leg, often extending below the knee. It commonly results from irritation or compression of a lumbar nerve root.

Patients may experience:

• Pain radiating down one or both legs

• Numbness or tingling in the leg or foot

• Burning or shooting pain

• Leg weakness

• Difficulty standing, walking, or performing work activities

Lumbar Spinal Stenosis

Lumbar spinal stenosis is a narrowing of the spinal canal or nerve openings that can compress spinal nerves. Symptoms may include lower back pain, leg discomfort, numbness, and difficulty walking or standing for prolonged periods.

Lumbar Facet Joint Pain

The facet joints are small joints in the back of the spine that help provide stability and allow movement. Injury or degeneration of these joints can contribute to localized lower back pain, particularly with extension, twisting, or prolonged standing.

Dr. Bovonratwet also offers specialized minimally invasive and endoscopic treatment options for selected patients with persistent facet-mediated back pain.

Evaluation of Workers’ Compensation Back Injuries

An accurate diagnosis is an important first step in determining the appropriate treatment for a work-related back injury.

During a spine consultation, Dr. Bovonratwet evaluates the patient's symptoms, medical history, physical examination findings, and relevant imaging studies.

The evaluation may include:

• Review of the workplace injury and mechanism of injury

• Assessment of lower back pain and radiating leg symptoms

• Neurological examination, including strength, sensation, and reflexes

• Review of MRI, CT, and X-ray imaging when available

• Assessment of previous treatments and response to care

• Discussion of treatment recommendations and potential next steps

The goal is to identify the source of symptoms and determine whether additional nonsurgical treatment, diagnostic evaluation, or surgical intervention may be appropriate.

Treatment Options for Work-Related Back Pain and Sciatica

Treatment recommendations depend on the specific spinal condition, severity of symptoms, neurological findings, and response to previous treatment. Not every patient with a work-related back injury requires surgery.

Nonsurgical Treatment

Many patients can initially be treated without surgery. Depending on the underlying condition, treatment may include:

• Physical therapy and guided rehabilitation

• Activity modification

• Anti-inflammatory medications or other appropriate medications

• Epidural steroid injections

• Other targeted pain management procedures

When appropriate, nonsurgical treatment may help improve symptoms and restore function without an operation.

Minimally Invasive Spine Surgery

For patients with persistent symptoms caused by nerve compression who have not improved with appropriate nonsurgical treatment, minimally invasive spine surgery may be considered.

Dr. Bovonratwet specializes in minimally invasive lumbar spine procedures using small incisions and specialized tubular retractors.

Depending on the condition, procedures may include:

• Lumbar microdiscectomy for herniated discs

• Lumbar laminectomy for spinal stenosis

• Minimally invasive decompression of compressed spinal nerves

These techniques are designed to minimize disruption to surrounding muscles and soft tissues while addressing the underlying spinal pathology.

Endoscopic Spine Surgery

Endoscopic spine surgery uses a small camera and specialized instruments to visualize and treat selected spinal conditions through small incisions.

For appropriately selected patients, endoscopic procedures may offer an alternative approach to treating lumbar disc herniations and certain forms of spinal nerve compression.

Dr. Bovonratwet offers both uniportal and biportal endoscopic spine surgery techniques at Mass General.

Not every spinal condition is suitable for endoscopic surgery. The appropriate approach depends on the location and nature of the underlying pathology.

Workers’ Compensation Spine Consultations at Mass General

Dr. Bovonratwet evaluates patients with work-related spine injuries at Massachusetts General Hospital.

Patients seeking a workers' compensation spine consultation may include:

• Individuals with persistent back pain following a workplace injury

• Patients experiencing sciatica or radiating leg pain

• Workers diagnosed with a lumbar herniated disc

• Patients who have not improved with physical therapy, medications, or injections

• Individuals seeking a spine surgery consultation or second opinion

The evaluation focuses on understanding the underlying spinal condition and providing an individualized treatment recommendation.

When additional orthopaedic evaluation is needed, patients may also have access to other orthopaedic specialties within the Mass General system.