Lumbar Diskography and Failed Back Syndrome in Patients Receiving Workers' Compensation

Area of Science:

• Spine surgery outcomes
• Pain management

Background:

• Lumbar diskography (LD) is used for degenerative disk disease and diskogenic low back pain.
• Its safety and diagnostic accuracy are debated, with no prior studies in the workers' compensation population.
• This study evaluates LD's impact on postoperative outcomes in this specific group.

Purpose of the Study:

• To determine if LD before diskogenic fusion affects rates of failed back surgery syndrome (FBSS).
• To compare postoperative opioid analgesic use between patients who underwent LD and those who did not.

Main Methods:

• Retrospective review of 1591 workers' compensation patients undergoing diskogenic fusion (1993-2013).
• Identified 682 patients who had LD before fusion (LD group) and 909 controls.
• Used multivariate logistic regression analysis, controlling for covariates.

Main Results:

• LD before fusion predicted higher rates of postoperative FBSS (13.9% vs. 8.8%; P=.04).
• The LD group received higher daily opioid doses for 130 more days postoperatively (P<.01).
• Other FBSS predictors included inability to work within 1 week, male sex, long-term preoperative narcotic use, and fusion technique.

Conclusions:

• Lumbar diskography before fusion is associated with increased FBSS and opioid use in workers' compensation patients.
• These findings raise concerns about the current utility of LD in this population.
• Further research is needed to clarify LD's role in patient selection for lumbar fusion.