For workers' compensation patients with chronic low back pain, spinal fusion surgery leads to worse long-term outcomes—including a lower rate of return to work—compared to nonsurgical treatment, suggests a study in the February 15th issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
At a time of continued debate over the role of spinal fusion surgery (lumbar arthrodesis), the results suggest that this operation "may not be an effective operation for workers' compensation patients" with certain causes of low back pain. The lead author was Dr. Trang H. Nguyen of University of Cincinnati College of Medicine.
Poorer Outcomes in Workers Undergoing Spinal Fusion
Using Ohio workers' compensation data, Dr. Nguyen and co-authors identified 725 workers with chronic low back pain who underwent spinal fusion surgery. Spinal fusion is an operation done to fuse together adjacent vertebrae in certain types of chronic back problems. Most of the patients in the study had degenerative disc disease, herniated discs, or nerve root disease (radiculopathy).
The researchers assessed the final treatment outcomes—including return to work, disability, and use of strong pain medications (opioids)—at two years' follow-up. They compared the results of spinal fusion with those in a random sample of 725 patients who underwent nonsurgical, conservative treatments (such as physical therapy, exercise, etc).
Almost all categories of outcomes were worse for patients undergoing spinal fusion. Just over one-fourth of spinal fusion patients had returned to work, compared to two-thirds of those treated without surgery. Twenty-seven percent of patients in the spinal fusion group had repeat surgery, while 36 percent experienced some type of complication.
Eleven percent of the spinal fusion patients had permanent disability, compared with two percent of patients treated without surgery. Most spinal fusion patients continued using opioid drugs after their surgery, with many taking higher doses. There were also more deaths in the spinal fusion group.
The use of spinal fusion surgery for chronic low back pain has increased dramatically in recent years—despite a lack of consistent evidence that it improves patient outcomes. Few previous studies have looked at the use of spinal fusion surgery, compared to nonsurgical treatment, in workers' compensation patients.
Although it's not a controlled scientific trial, the study raises questions about the long-term effectiveness of spinal fusion surgery for workers' compensation patients with chronic low back pain. Dr. Nguyen and co-authors write, "This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor return to work status, and higher doses of opioids."
They also note the lack of evidence supporting the use of spinal fusion for degenerative disc disease, herniated discs, or radiculopathy—the diagnoses present in most of the workers in the study. Spinal fusion should be "cautiously considered" in workers' compensation patients, Dr. Nguyen and coauthors believe—and then only for patients with diagnoses for which spinal fusion has proven specifically effective.