Effects of 360-Degree Lumbar Fusion in a Workers' Compensation Population

Abstract

Study Design. Eighty-one patients who were receiving workers' compensation and who met structured inclusion criteria for low back pain and disability underwent 360° lumbar fusion with decompression and were compared to 16 similar patients who did not receive the surgery because of administrative reasons outside the authors' control. Patients completed standardized questionnaires to assess their level of functioning before surgery and every 6 months after surgery for 24 months or more. Objectives. To determine the efficacy of 360° lumbar fusion within a sample of patients receiving workers' compensation using sound methods of outcome evaluation. Summary of Background Data. The results of previous studies have shown that lumbar fusion may not be effective with patients receiving workers' compensation. Unsound methods preclude firm conclusions, however, and the data on pathophysiology of lumbar spine injuries suggests a multiplicity of pain generators in these patients. The 360° lumbar fusion with generous decompression surgery described in this report addresses these pain generator mechanisms. Method. Patients completed valid and reliable questionnaires independent of the surgeon's input before surgery and every 6 months after surgery. Data were examined in groups (surgery and nonsurgery) multiplied by assessment time (before surgery, 0-6 months, 6-18 months, 18-24 months, and 24+ months) analysis of variance. Results. Ninety-one percent of patients who underwent surgery reported a positive response. Compared with the nonsurgery group, these patients reported reduced pain intensity, increased activity level, decreased disability, and improved confidence in performing routine activities. Differences were maintained at all follow-up examinations, although only one-third of the patients who underwent surgery were available at the final follow-up examination. No differences were observed on measures of emotional health. Conclusions. Circumferential (360°) lumbar fusion can be a highly effective method of reducing pain and disability in patients receiving workers' compensation.