Lumbar Fusion Outcomes in Washington State Workers’ Compensation

Abstract

Use of intervertebral fusion devices rose rapidly after their introduction in 1996. This increased use was associated with an increased complication risk without improving disability or reoperation rates.

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

“…18 Lumbar cage fusion rates increased from 3.6% in 1996 to 58% in 2001, and the result was increased complication risk without improved disability or reoperation rates. 19 Adjacent segment degenerative changes and instability at the level immediately above single-segment fusion with clinical deterioration are shown in up to 90% of the cases. [20][21][22][23] The incidence of radiographic adjacent segment disease following fusion has been reported to be as high as 50% in the cervical spine and 70% in the lumbar spine at 10 years.…”

Lumbar Surgery in Work-Related Chronic Low Back Pain: Can a Continuum of Care Enhance Outcomes?

“…A large population-based study of fusions within the Washington State WC setting revealed a 22% re-operation rate and a low return-to-work rate of 36%, at 2-years post-surgery. 7 A more recent study in the Ohio WC jurisdiction showed similar results, with a 26% return to work rate and a 27% re-operation rate, as well as a opioid dependence disorder (ODD) still noted in 85% of fusion patients 2 years postoperative. 6 Outcomes in the Utah WC jurisdiction were comparable.…”

“…This finding provided contrast to much lower work status outcomes in prior WC spine surgery publications. [6][7][8] In addition, there were no differences in rates of additional surgery (1.2-3.7%) or new compensable injuries. These non-significant differences among groups may hide the fact that the additional surgery rates for the surgical groups ranged from 3.3-3.7%, well below fusion reoperation rates of 22-27% in recent lumbar fusion WC claim studies.…”

“…1,2 There has also been a debate in the scientific literature about the long-term effectiveness of spinal fusion surgery for chronic (especially discogenic) low back pain. 3,4 Findings, such as low work return, high re-operation rates, and highly prevalent opioid dependence have been demonstrated in different WC jurisdictions, [5][6][7] and have led to limitations on recommendations for spinal fusion in WC claims by the largest evidencebased national guidelines, resulting in a lower surgical approval rates in a growing number of state jurisdictions mandating use of these guidelines. 8,9 It has been suggested that similar guidelines will be incorporated into group health and Medicare settings with the expansion of national health insurance.…”

Evolução dos questionários Oswestry 2.0 e do componente físico (PCS) do SF-36 durante o primeiro ano de pós-operatório de artrodese da coluna lombar em doenças degenerativas

“…13 Essa modalidade de tratamento apresenta como vantagens a eliminação do movimento do segmento afetado, que pode ser uma das causas da dor, e a possibilidade de uma descompressão ampla das estruturas acometidas. 14,15 O enxerto ósseo para fusão da coluna pode ser obtido de fontes locais como facetas, lâminas e processo espinhoso, do ilíaco ou ainda de banco de osso (aloenxerto). A instrumentação da coluna lombar no procedimento de artrodese é utilizada para aumentar a taxa de fusão, diminuir o tempo de imobilização e, com isso, melhorar os resultados cirúrgicos a longo prazo.…”