Article courtesy of The Heritage News - MD Speak - By Summit Medical Director Kenneth G. Phillips, M.D., MPH, FACOEM, FAIHQ, CIME
The latest issue of The Heritage News highlighted a study on the success rates of lumbar discectomy among professional football players. The study analyzed postoperative player performance and showed some exciting results. Fro those players who returned to the game, there was no significant difference in performance when compairing pre injury and post injury performance statistics.
This time around, we are sharing a study on the more intensive spinal fusion surgery, titled Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study.
The study included 725 fusion cases, and matched them with a control group of 725 randomly-selected, non-surgical, chronic low back pain cases. Each group was evaluated after two years (after surgery for the fusion group, and after injury for the control group).
At evaluation, 26 percent of the fusion cases had returned to work, compared with 67 percent of the fusion cases of the controls. Fusion cases saw an 11 percent permanent disability rate while controls saw only 2 percent. In addition, the total number of days off work was 1,140 for fusion cases and only 316 days for controls.
The fusion cases also had a 27 percent reoperation rate, a 36 percent complication rate and a 41 percent increase in daily opioid use.
The study concluded that "lumbar fusion for the diagnosis of disc degeneration, disc herniation, and/or radiculopathy in a workers' compensation setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor return to work status. " Clearly, while the discectomy study showed exciting results, this study of spinal fusion highlighted much poorer outcomes.
At summit, we base out treatment authorization decisions on the Official Disability Guidelines (ODG). When this research was published in early 2011, ODG included its findings in their treatment recommendations.
As it stands now, ODG lists the following as their position on spinal fusion.
Patients with on-the-job injuries are three to five times more likely as other patients to have a bad outcome from spinal fusion (Harris-JAMA, 2005). A recent study of workers' comp patients in Ohio who had lumbar fusion found that only 6 percent were able to go back to work a year later, 27 percent needed another operation, and over 90 percent were in enough pain that they were still taking narcotics at follow-up (Nguyen, 2007). Until further research is conducted, there remains insufficient evidence to recommend fusion for chronic low back pain in the absence of stenosis and spondylolisthesis.
* Quick reference guide
Back conditions and surgery terms:
Discectomy- the surgical removal of the damaged portion of a herniated disk in the spine.
Spinal fusion- Surgical removal of entire damaged disks, permanently connecting two or more vertebrae in the spine and eliminating motion between them.
Spinal stenosis- A narrowing of the open spaces within the spine, which can put pressure on the spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back.
Spondylolisthesis- A spinal disorder in which one vertebra slips forward and onto the vertebra below it.