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Return to Work Delayed After Lumbar Fusion

Increased disability, opioid use, reoperations, and complications after lumbar fusion surgery

THURSDAY, Feb. 24 (HealthDay News) -- Lumbar fusion surgery is associated with poor return to work (RTW) status, as well as increased disability, opiate use, reoperations, and complications, according to research published in the Feb. 15 issue of Spine.

Trang H. Nguyen, M.D., Ph.D., from the University of Cincinnati College of Medicine in Milford, Ohio, and colleagues compared data from 725 lumbar fusion cases with 725 randomly selected workers' compensation control subjects who had chronic low back pain from an injury between 1999 and 2001. The primary outcome was an RTW status two years after the date of surgery in the lumbar fusion cases, and from the date of injury in the controls. Other factors, including disability, complications, reoperations, opioid usage, and deaths, were evaluated.

The investigators found that after two years, 26 percent of the fusion cases and 67 percent of the controls had achieved RTW status. The number of days off before surgery, reoperation, complications, daily morphine usage, and legal representation were all identified as predictors of RTW in the fusion cases. Daily opioid use among those who underwent lumbar fusion increased 41 percent after surgery, with 76 percent using opioids post-surgery; in addition, 36 percent developed complications and 27 percent underwent reoperations. Those who had lumbar surgery took more days off work, and had increased permanent disability rates (11 percent for cases and 2 percent controls) and higher morbidity compared to controls (17 cases compared to 11 controls).

"This large historical cohort study suggests that lumbar fusion may not be an effective operation in workers' compensation patients with the diagnoses of disc degeneration, disc herniation, and/or radiculopathy," the authors write.

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