title: Spine surgery outcomes in a workers' compensation cohort.
abstract: BACKGROUND
  Lumbar spine surgery (fusion, disc replacement or decompression) is common, yet indications are unclear and outcomes, particularly in a workers' compensation setting, are not consistently favourable. This study aimed to determine the outcomes of spine surgery in an Australian workers' compensation cohort.
  
  
  METHODS
  A retrospective review of prospectively collected data from WorkCover NSW and insurer agents was performed. Subjects were included if they had lumbar spine decompression, fusion or disc replacement procedures performed between 1 January 2004 and 31 December 2006 (inclusive). Main outcome measures were as follows: need for further lumbar spine surgery, return to work (RTW), return to pre-injury duties (PID) and need for ongoing physical treatment or prescription opioids. All outcomes were measured at 24 months post-surgery.
  
  
  RESULTS
  A total of 476 patients had undergone lumbar spine surgery within the workers' compensation system. The revision surgery rate was 9.2%. The RTW rate and return to PID rate were 50.3% and 14.2%, respectively. The proportion of patients still undergoing treatment was 77.7%. The rates of RTW (or PID) and need for ongoing treatment were significantly worse in patients undergoing fusion and disc replacement, compared with patients undergoing decompressive procedures (laminectomy, discectomy).
  
  
  CONCLUSIONS
  The findings do not support the use of lumbar spine fusion or disc replacement surgery as a method of achieving RTW and relief of pain in patients treated under workers' compensation.
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia. ianharris@unsw.edu.au
authors.forename: Ian A
authors.initials: IA
authors.lastname: Harris
authors.forename: Nandu
authors.initials: N
authors.lastname: Dantanarayana
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D019637:Orthopedic Procedures; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062707:Return to Work; D013123:Spinal Fusion; D059145:Total Disc Replacement; D016896:Treatment Outcome; D014942:Workers' Compensation; D055815:Young Adult