A new study published in The Spine Journal examines workers compensation patients undergoing single-level posterolateral fusion for spondylolisthesis or degenerative disc disease.
There were 889 patients involved in the study who underwent surgery with or without posterior interbody from 1993 to 2010. There were 269 who underwent surgery for spondylolisthesis and 620 who underwent fusion for DDD.
The researchers found:
1. The patients who underwent fusion for spondylolisthesis were positively associated with return-to-work status with an odds ratio of 1.42 and 95 percent confidence interval.
2. There were 26.4 percent of the spondylolisthesis patients and 24.4 percent of the DDD patients who were able to return to work in a "reasonable" timeline postoperatively. The reasonable timeline was within two years of the fusion and then remaining at work for more than six months of the following year.
3. The negative predictors for outcomes were:
• Waiting more than two years between the injury and index fusion
• 50 years old or older at surgery
• Permanent disability
• Legal representation
• Psychological comorbidity before fusion
4. The patients in the DDD cohort were prescribed opioid analgesics for an average of 294 additional days postoperatively, which is 24,759 additional milligrams of morphine equivalents.
5. "Our study is supportive of the conclusion that DDD is a questionable indication for spinal fusion," concluded the study authors. "Given the generally poor outcomes of this study, future studies should determine if lumbar fusion surgery is an effective treatment modality in similar patients with WC."