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Spine surgery outcomes in a workers' compensation cohort
Ian A Harris1, Nandu Dantanarayana, Justine M Naylor
1South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia. ianharris@unsw.edu.au
ANZ Journal of Surgery
|August 14, 2012
Summary
Lumbar spine fusion and disc replacement surgeries show poor outcomes for workers' compensation patients, failing to improve return to work rates or reduce ongoing treatment needs. Decompressive procedures appear more favourable.
Area of Science:
- Orthopedics
- Neurosurgery
- Occupational Health
Background:
- Lumbar spine surgery is frequently performed, but indications and outcomes, especially for workers' compensation cases, are not consistently favorable.
- This study evaluates the effectiveness of different lumbar spine surgical procedures within an Australian workers' compensation cohort.
Purpose of the Study:
- To determine the outcomes of lumbar spine decompression, fusion, and disc replacement surgeries in Australian workers' compensation patients.
- To compare the effectiveness of different surgical approaches regarding return to work and need for ongoing treatment.
Main Methods:
- Retrospective review of prospectively collected data from WorkCover NSW and insurer agents.
- Inclusion criteria: lumbar spine decompression, fusion, or disc replacement between January 2004 and December 2006.
- Outcome measures at 24 months: further surgery, return to work (RTW), return to pre-injury duties (PID), and ongoing treatment needs.
Main Results:
- 476 patients underwent lumbar spine surgery; 9.2% required revision surgery.
- Return to work (RTW) and return to pre-injury duties (PID) rates were 50.3% and 14.2%, respectively.
- Fusion and disc replacement showed significantly worse RTW/PID rates and higher ongoing treatment needs compared to decompressive procedures.
Conclusions:
- Findings do not support lumbar spine fusion or disc replacement for achieving RTW or pain relief in workers' compensation patients.
- Decompressive lumbar spine surgery may offer better outcomes for this patient group.
