October 15, 2013
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Continuum of care concept can improve lumbar surgery outcomes for delayed recovery patients

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NEW ORLEANS — A continuum of care concept that incorporates a functional restoration program and surgery can improve results in workers’ compensation patients with chronic low back pain, according to the results of a prospective study presented here.

“In this workers’ compensation population, early intervention after surgery in a continuum of care concept can avoid delayed recovery and presumably move up the time to where people become productive again after major spine surgeries. The study also shows that even complex patients with multiple prior surgeries can improve in outcomes if appropriate care is provided after the failure of initial nonoperative care,” Tom G. Mayer, MD, said at the North American Spine Society Annual Meeting.

Mayer and colleagues compared 349 patients who underwent fusion, 239 patients who had discectomy and decompression and 349 nonoperated controls who matched the surgical patients for length of disability. The investigators conducted structured interviews of the patients at 1 year about their return to work, work retention, additional number of spine surgeries, subsequent number of workers’ compensation claims for those who returned to work and number of cases that were settled.

Patients in the fusion group had a significantly longer length of disability compared with the other cohorts. The time from surgery to participating in the continuum of care program was about 1 year for the nonfusion group and 1.5 years for the fusion cohort. Prior to treatment, Mayer said there were marginal differences between the groups for pain and depression. However, these differences disappeared at the end of treatment.

“The only interesting psychosocial measure was opioid dependence,” Mayer said noting rates of 17% for the unoperated group, 19% for the nonfusion group and 31% for the fusion group.  At 1-year, there were no significant differences between the groups for socioeconomic outcomes.

“The return to work varied from 81% to 85%; work retention [ranged] from 74% to 81%; 1.5% to 3.5% had additional surgery and 1.5% to 2.5% had no additional injury claims,” Mayer said.

“Another interesting finding was that only opioid dependence predicted work return and work retention,” he said. “The type of surgery, whether they were operated, was not a predictor.”

Reference:

Mayer TG. Paper #33. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans.

Disclosure: Mayer has no relevant financial disclosures.