A study recently published by the National Center for Biotechnology Information and also published in the medical journal Spine reflects what experience workers compensation adjusters already knew – lumbar fusion surgery often does not work. The study, from January 1, 1999 to January 31, 2006, was completed by researchers at the University of Cincinnati College of Medicine, Meharry Medical College and the University of Kentucky College of Medicine came to the following conclusions: lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers compensation setting is associated with significant increase in disability, opiate use, prolonged work loss and poor return to work results.
In 2007, the Agency for Healthcare Research and Quality (an agency within the U.S. Department of Health and Human Services), estimated 27 million adults in the USA have back problems and spend $30 billion annually on medical treatments including physical therapy, pain management, chiropractor visits, other non-invasive therapies and spine surgeries.
Back pain can be excruciating and unrelenting. For an employee who is in constant pain, the appeal of relief from the pain through back surgery is often incentive enough to opt for lumbar fusion. According to a second (different) study published in the Spine journal, lumbar fusion of two or more vertebrae has had an eight-fold increase in the last 15 years. There is a definite concern among some orthopedics that the use of spinal surgery has gone beyond what is necessary or reasonable. Approximately 600,000 Americans have back surgeries each year.
The researchers reviewed the medical records of 1,450 workers compensation claims in the Ohio Bureau of Workers Compensation database. The three medical conditions involving back surgery included in the study were disc degeneration, disc herniation, and radiculopathy. Half of the employee claimants had surgery to fuse two or more vertebrae. The other half of the employee claimants did not have surgery even though their diagnoses were comparable.
Of the 725 employee claimants who had elected to have a lumbar fusion, only 188 (26%) of the employee claimants had returned to work within two years of the surgery. Among the 725 employee claimants who chose not to have the back surgery, 483 (67%) had returned to work within two years.
It should also be noted that of the 725 employee claimants who elected to have surgery, 194 (27%) of them had to have a second back surgery due to the poor results of the first back surgery. Also, of the other employee claimants who had back surgery, 264 (36%) had complications to develop.
Of the employees claimants who had the lumbar surgery, 82 (11%) were deemed to be totally and permanently disabled, while only 11 (2%) of the employee claimants who did not have back surgery were determined to be totally disabled.
The primary reason given for having the back surgery was to mitigate or control the pain associated with the back injury. Prior to surgery many employee claimants are taking opiates to relieve the pain. Among the employee claimants who had back surgery, 550 (76%) continued the use of opiates after the surgery. Another aspect of the study (that experienced work comp adjusters already knew) is that back surgery results not in a decrease in the use of opiates, but an increase in the use of painkillers. The researchers found that back surgeries result in a 41% increase in the use of painkillers, specifically opiates.
The average number of work days missed by the employee claimants who had lumber fusion was 1,140 days per employee. Among the employee claimants who elected not to have back surgery, the average number of days missed per employee was 316.
Dr. Trang Nguyen, the lead researcher of the study, concluded that there is no easy solution for employees with bad backs. With proper treatment, the back pain can be eased, and the employee can learn to live with the bad back, but that a complete cure is unlikely.
While many workers compensation adjuster could say “I could have told the researchers that and save them a lot of time”, the documentation by independent medical researchers moves it from subjective opinion to objective fact. While some spinal fusions are necessary, the employee claimant should always be encouraged to get a second opinion before having the back surgery.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
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