Socioeconomic outcomes of combined spine surgery and functional restoration in worker's compensation spinal disorders with matched controls

Tom Mayer, Margaret J. McMahon, Robert J. Gatchel, Brett Sparks, Anna Wright, Pauline Pegues

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85 Scopus citations

Abstract

Study Design. A longitudinal cohort study in (n = 448) comparing functionally restored discectomy (n - 123) and fusion (n = 101) workers compensation patients to matched unoperated control patients in (n = 123 and n = 101, respectively. Objectives. To determine successful treatment out comes uniquely important in a workers compensation environment when spine surgery is combined with comprehensive tertiary, rehabilitation to optimize anatomic and social sequlae. Summary of Background Data. Multiple recent studies confirm suboptimal socioeconomic outcomes of spinal surgery for degenerative conditions in a workers compensation venue. In other musculoskeletal regions there is a clear relationship between the quality of post surgical rehabilitation and the impact on disability, recurrent injury, and future health care use. It is hypothesized that poor surgical outcomes in compensation injuries may result from outmoded postoperative methods, rather than failures of patient selection or surgical techniques. No previous combination of surgery plus rehabilitation has been carefully evaluated with disabled workers undergoing spine surgery. Functional restoration is an individualized medically directed interdisciplinary program using quantitatively directed exercise progressly on psychotherapeutic interventions and monitoring of specific socioeconomic outcomes for chronically disabled workers. Method. This study prospectively evaluated a cohort of consecutive functional restoration program graduates (n = 1202) Two surgical groups discectomy (n = 123) and fusion (n = 101) were matched to two groups of unoperated control patients control discectomy and control fusion selected from the same cohort of patients with chronic spinal disorders based on age gender, race, length of disability and workers compensation jurisdiction. A structured clinical interview was administered 12 months after program completion with a contact rate of 95% to 98%. Results. Socioeconomic out comes for work return health care use and recurrent lost time injury were assessed. All groups demonstrated a return-to-work incidence of more than 85% but work retention at 1 year was higher for the fusion group than for the discectomy or control/fusion group. Healthcare use was significantly higher for the discectomy group than the control discectomy of fusion groups for reoperation (8% vs. 4% 2%), as well as other factors. All groups showed comparable recurrent lost-time injury rates (2-3.3%) and made comparable improvements in prospectively collected physical and psychological measures. Conclusions. Discectomy patients had work health care utilization and recurrent injury outcomes comparable with those for unoperated control patients. Fusion patients had better outcomes of work retention, reoperation, and health care use compared with the unoperated control patients and even with discectomy patients, in spite of more cases of previous surgery and greater, duration of disability. The discectomy and fusion cohorts of operated chronic spinal disorder compensation patients with subsequent functional restoration had the best documented outcomes found in the literature for this population in spite of the common presumption that spine surgery patients are poorly in a workers' compensation environment measurement demonstrate that such patients can show remarkably successful objective outcomes if accompanies by effective rehabilitation documenting efficacy and clinical utility. A new clinical approach is required to evaluate prospective the combination of surgery and rehabilitation in chronic pain/disability workers compensation patients in which the surgical role is to correct an anatomic lesion; but the socioeconomic outcomes either occur spontaneously or are effected through some form of rehabilitation.

Original languageEnglish
Pages (from-to)598-606
Number of pages9
JournalSpine
Volume23
Issue number5
DOIs
StatePublished - 1 Mar 1998

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Keywords

  • Chronic pain
  • Compensation
  • Disability
  • Discectomy
  • Functional restoration
  • Matched controls
  • Outcomes
  • Spine fusion
  • Spine surgery
  • Workers

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