Mayer Tom G, Anagnostis Christopher, Gatchel Robert J, Evans Trent
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5701 Maple Avenue, #100, Dallas, TX 75235, USA.
Spine J. 2002 Jul-Aug;2(4):267-73. doi: 10.1016/s1529-9430(02)00208-5.
Spinal surgery in the workers compensation population shows evidence of less favorable outcomes than in general health cases. Although spine surgery has been alleged to be a cause of poor outcomes, such outcomes may be improved by appropriate postsurgical rehabilitation.
To compare objective demographic, physical and psychological measurements and socioeconomic outcomes of treatment in work-related disabling cervical pain for the combination of anterior cervical fusion (ACF) plus functional restoration, compared with rehabilitation alone.
STUDY DESIGN/SETTING: A prospective study of patients undergoing ACF for degenerative disc disease before rehabilitation for work-related musculoskeletal disorders versus neck pain unoperated controls, with data collected in an outpatient tertiary interdisciplinary rehabilitation setting.
A group of 52 patients completed a functional restoration treatment program after undergoing ACF (Group S) at one or two levels for degenerative cervical disc disease. During the study period, 625 patients with work-related neck pain were identified from the same study population, from which a rehabilitation (Group R) comparison group (n=150) was identified who were stratified according to the number and location of other compensable body parts.
Socioeconomic outcomes relevant to chronic disabling work-related cervical spinal disorders are reported based on 1-year posttreatment interviews. Pre- to posttreatment assessment of pain intensity, disability, depression and cumulative physical capability were assessed prospectively.
All patients were totally or partially disabled before completing an intensive, medically supervised, functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach. Preprogram preparation included drug detoxification, psychotropic medication management and preparatory aerobic and mobility training. The intensive treatment phase involved strength and endurance training, with counseling geared to goals of work return and fitness maintenance. The 1-year structured clinical interview had a contact rate of 93% to 95%, and partial information acquisition on all patients.
Although Group S had lower work return and work retention outcomes, the differences were not significant. Group S patients had significantly more health utilization from a new provider in the year after completion of functional restoration (46% vs 24%; OR=2.7 [1.3, 5.3], p<.004). Group S patients were also more likely to be depressed, both at pre- and postrehabilitation. There were no significant differences in recurrent injury, additional surgery, physical measures or pain/disability self-report between the groups.
Workers compensation patients with chronic disabling work-related cervical spinal disorders who undergo a cervical fusion, combined with functional restoration, have socioeconomic outcomes after their surgery statistically similar to those for unoperated controls. Surgery patients had a higher rate of additional health-care-seeking behaviors from new providers and a greater likelihood of being clinically depressed before and after rehabilitation. This study suggests that cervical fusion for degenerative disc disease in workers compensation patients is not contraindicated, as long as interdisciplinary rehabilitation is available for complex cases after the surgical procedure.
工人赔偿人群中的脊柱手术显示出比一般健康病例预后更不理想的证据。尽管脊柱手术被认为是导致不良预后的一个原因，但通过适当的术后康复，这种预后可能会得到改善。
比较前路颈椎融合术（ACF）加功能恢复与单纯康复治疗在与工作相关的致残性颈痛治疗中的客观人口统计学、身体和心理测量指标以及社会经济结局。
研究设计/地点：一项前瞻性研究，研究对象为因退行性椎间盘疾病接受ACF治疗的患者，在进行与工作相关的肌肉骨骼疾病康复治疗之前，与未接受手术的颈部疼痛对照组进行比较，数据在门诊三级跨学科康复机构收集。
一组52例患者在因退行性颈椎间盘疾病接受一或两个节段的ACF治疗后，完成了功能恢复治疗计划（S组）。在研究期间，从同一研究人群中识别出625例与工作相关的颈部疼痛患者，从中确定了一个康复治疗（R组）比较组（n = 150），该组根据其他可补偿身体部位的数量和位置进行分层。
根据治疗后1年的访谈报告与慢性致残性与工作相关的颈椎疾病相关的社会经济结局。前瞻性评估治疗前后的疼痛强度、残疾程度、抑郁程度和累积身体能力。
所有患者在完成一项强化的、医学监督的功能恢复计划之前均完全或部分残疾，该计划将定量指导的运动进展与多模式残疾管理方法相结合。计划前准备包括药物戒毒、精神药物管理以及预备性有氧运动和活动能力训练。强化治疗阶段包括力量和耐力训练，并针对恢复工作和维持健康的目标进行咨询。1年的结构化临床访谈接触率为93%至95%，并获取了所有患者的部分信息。
尽管S组的工作恢复和工作保留结局较低，但差异不显著。S组患者在功能恢复完成后的一年中，来自新医疗服务提供者的医疗服务利用率显著更高（46%对24%；OR = 2.7 [1.3, 5.3]，p <.004）。S组患者在康复前后也更有可能出现抑郁。两组之间在复发性损伤、额外手术、身体测量指标或疼痛/残疾自我报告方面没有显著差异。
因与工作相关的慢性致残性颈椎疾病而接受颈椎融合术并结合功能恢复的工人赔偿患者，其术后的社会经济结局在统计学上与未接受手术的对照组相似。手术患者从新医疗服务提供者处寻求额外医疗保健行为的发生率更高，并且在康复前后临床抑郁的可能性更大。这项研究表明，只要术后能为复杂病例提供跨学科康复治疗，工人赔偿患者因退行性椎间盘疾病进行颈椎融合术并非禁忌。
