Outcomes of Posterolateral Lumbar Fusion in Utah Patients Receiving Workers’ Compensation

Abstract

A retrospective cohort study consisting of a medical record review and a follow-up telephone survey of patients with lumbar fusion, at least 2 years after their surgery, was performed. To identify presurgical correlates and long-term outcomes from posterolateral lumbar fusion in Utah patients receiving workers’ compensation. Lumbar fusion has been criticized for its highly variable outcomes, and compensated workers are at particular risk for poor outcomes. Evidence suggests that presurgical psychosocial factors may be important modifiers of back pain reporting and back surgery outcomes. The patients in this study were 185 compensated workers in Utah who underwent posterolateral lumbar fusion. Patient medical records were independently reviewed, and medical and sociodemographic variables were coded. A telephone outcome survey was completed with 130 patients (70%) an average of 4.6 years after their surgery. Reported solid fusion, reoperation, and disability rates for the follow-up sample were 74%, 24%, and 25%, respectively. As reported by the patients, 41% experienced no change or a worsened quality of life. Mean scores from the Roland and Morris Back Pain Disability Questionnaire, the Stauffer-Coventry-Index, and the Short-Form 20 Multidimensional Health Survey indicate that many patients experienced postsurgical dysfunction. Presurgical predictors of outcomes were number of prior low back operations, income at time of injury, age, litigation, and depression. Outcomes of posterolateral lumbar fusion among compensated workers in Utah are inconsistent. Outcomes can be predicted by presurgical sociodemographic variables. Screening for such presurgical risk factors may be important for prudent surgical decisions and rehabilitation planning.