Division of Epidemiology and Biostatistics, Department of -Environmental Health, University of Cincinnati College of Medicine, Milford, OH, USA.
Spine (Phila Pa 1976). 2011 Feb 15;36(4):320-31. doi: 10.1097/BRS.0b013e3181ccc220.
Historical cohort study.
To determine objective outcomes of return to work (RTW), permanent disability, postsurgical complications, opiate utilization, and reoperation status for chronic low back pain subjects with lumbar fusion. Similarly, RTW status, permanent disability, and opiate utilization were also measured for nonsurgical controls.
A historical cohort study of workers' compensation (WC) subjects with lumbar arthrodesis and randomly selected controls to evaluate multiple objective outcomes has not been previously published.
A total of 725 lumbar fusion cases were compared to 725 controls who were randomly selected from a pool of WC subjects with chronic low back pain diagnoses with dates of injury between January 1, 1999 and December 31, 2001. The study ended on January 31, 2006. Main outcomes were reported as RTW status 2 years after the date of injury (for controls) or 2 years after date of surgery (for cases). Disability, reoperations, complications, opioid usage, and deaths were also deter-mined.
Two years after fusion surgery, 26% (n = 188) of fusion cases had RTW, while 67% (n = 483) of nonsurgical controls had RTW (P ≤ 0.001) within 2 years from the date of injury. The reoperation rate was 27% (n = 194) for surgical patients. Of the lumbar fusion subjects, 36% (n = 264) had complications. Permanent disability rates were 11% (n = 82) for cases and 2% (n = 11) for nonoperative controls (P ≤ 0.001). Seventeen surgical patients and 11 controls died by the end of the study (P = 0.26). For lumbar fusion subjects, daily opioid use increased 41% after surgery, with 76% (n = 550) of cases continuing opioid use after surgery. Total number of days off work was more prolonged for cases compared to controls, 1140 and 316 days, respectively (P < 0.001). Final multi-variate, logistic regression analysis indicated the number of days off before surgery odds ratio [OR], 0.94 (95% confidence interval [CI], 0.92-0.97); legal representation OR, 3.43 (95% CI, 1.58-7.41); daily morphine usage OR, 0.83 (95% CI, 0.71-0.98); reoperation OR, 0.42 (95% CI, 0.26-0.69); and complications OR, 0.25 (95% CI, 0.07-0.90), are significant predictors of RTW for lumbar fusion patients.
This Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor RTW status.
历史队列研究。
确定接受腰椎融合术的慢性下腰痛患者在重返工作岗位（RTW）、永久性残疾、术后并发症、阿片类药物使用和再次手术方面的客观结果。同样，也测量了非手术对照组的 RTW 状态、永久性残疾和阿片类药物使用情况。
以前没有发表过关于工人赔偿（WC）腰椎融合术患者和随机选择的对照组的历史队列研究，以评估多种客观结果。
将 725 例腰椎融合病例与 725 例从 1999 年 1 月 1 日至 2001 年 12 月 31 日受伤日期的慢性下腰痛 WC 受试者中随机选择的对照组进行比较。研究于 2006 年 1 月 31 日结束。主要结果报告为受伤日期后 2 年（对照组）或手术日期后 2 年（病例组）的 RTW 状态。还确定了残疾、再次手术、并发症、阿片类药物使用和死亡情况。
在融合手术后 2 年，26%（n=188）的融合病例有 RTW，而 67%（n=483）的非手术对照组在受伤后 2 年内有 RTW（P≤0.001）。手术患者的再手术率为 27%（n=194）。在腰椎融合患者中，36%（n=264）有并发症。病例组的永久性残疾率为 11%（n=82），非手术对照组为 2%（n=11）（P≤0.001）。研究结束时，17 名手术患者和 11 名对照者死亡（P=0.26）。对于腰椎融合患者，手术后阿片类药物的日使用量增加了 41%，其中 76%（n=550）的病例在手术后继续使用阿片类药物。与对照组相比，病例组的总休假天数更长，分别为 1140 天和 316 天（P<0.001）。最终的多变量逻辑回归分析表明，术前休假天数的优势比[OR]为 0.94（95%置信区间[CI]，0.92-0.97）；法律代表的 OR 为 3.43（95%CI，1.58-7.41）；每日吗啡使用量的 OR 为 0.83（95%CI，0.71-0.98）；再次手术的 OR 为 0.42（95%CI，0.26-0.69）；并发症的 OR 为 0.25（95%CI，0.07-0.90），这些都是腰椎融合患者 RTW 的显著预测因素。
在 WC 环境中，腰椎融合术用于椎间盘退变、椎间盘突出和/或神经根病变的诊断，与显著增加的残疾、阿片类药物使用、延长的工作损失和较差的 RTW 状态相关。
