Elsevier

Surgical Neurology

Volume 54, Issue 2, August 2000, Pages 101-108
Surgical Neurology

Spine
Late postoperative results in 1000 work related lumbar spine conditions

https://doi.org/10.1016/S0090-3019(00)00283-4Get rights and content

Abstract

BACKGROUND

Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman’s Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force.

METHODS

One thousand workmen’s compensation patients who had undergone lumbar spinal surgery were divided into two groups, one of 600 patients with single operations, evaluated on average 51 months after surgery, and the second of 400 with multiple operations, evaluated on average 38 months postoperatively.

RESULTS

Seventy-one percent of the single operation group had not returned to work more than 4 years after the operation, and 95% of the multiple operations group. In none of these cases was there a neurological deficit that precluded gainful employment, the failure to return to work being blamed on chronic postoperative pain.

CONCLUSIONS

Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.

Section snippets

Patient population

This study is based on a neuro-orthopedic examination of 1000 operated workers. Mailed follow-up questionnaires or telephone interviews were never used. To assure impartiality, none of the 1000 patients was evaluated by the treating surgeon. Under existing Workers Compensation Board regulations, a final examination to assess permanent partial incapacity and functional limitations may be required by the Board. This examination is usually carried out by a Board-appointed neurosurgeon or

Discussion

Review of the literature revealed that conventional lumbar discectomies showed a better outcome than fusion based on return to work rates within a year [18]. Low back pain persisting for more than half a year constitutes a watershed since little improvement can be expected even after several surgical procedures [60]. In one series 67.7% of patients described the backache as being worse after the operation, and 55.8% stated that quality of life had suffered [31]. Anterior fusion results were

Conclusion

Postoperative results in lumbar spine surgery in a Worker’s Compensation group remain disappointingly poor and are similar to findings in other reported series. There exists an astonishing discrepancy between the paucity of neurological deficits and the failure to reintegrate into the work force. The main problem appears to be chronic pain, according to the patients. Among various pain generating factors, periradicular fibrosis is mentioned with increasing frequency in the medical literature.

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