Surgery benefits workers’ comp patients with cervical degenerative disease

Issue: October 2012

AMSTERDAM — Workers’ compensation patients who underwent surgery for symptomatic cervical degenerative disease demonstrated significantly improved disability and pain scores 3 years postoperatively, despite reports in the literature that these patients do not benefit from surgery, according to data presented at SpineWeek 2012.

“If we look at evidence-based medicine, it would indicate that worker’s comp patients undergoing surgery receive less benefit than other patient groups,” Matthew F. Gornet, MD, of the Spine Research Center at the Orthopedic Center of St. Louis, said during the meeting. “In the SPORT study, they looked at low back pain in particular and they found a statistically significant improvement in back pain with surgery compared with nonoperative care. But when they teased out the workers’ compensation patients, they found there was no added benefit for that group.”

However, recent investigational device exemption studies have revealed significant improvement in pain and disability outcomes as well as significantly early return to work for workers’ compensation patients who underwent cervical disc arthroplasty compared with those who underwent anterior cervical discectomy and fusion, Gornet said.

Based on these data, Gornet and his colleagues conducted a 3-year prospective study of 223 patients from a single community-based practice with a large workers’ compensation population. All patients underwent cervical disc arthroplasty for symptomatic disc pathology after failed nonoperative measures; 157 patients were receiving workers’ compensation and 66 were not receiving compensation.

Researchers evaluated patients preoperatively and at 6 weeks, 3 months, 6 months, 12 months and 24 months; they also had a limited follow-up at 36 months. Demographic characteristics and preoperative disability and pain scores were similar between workers’ compensation and non-workers’ compensation patients. Ninety percent of patients in both groups underwent surgery at one or two levels.

Pictured is 3-month postoperative flexion and extension X-rays of a patient who now works full duty with no restrictions.

Images: Gornet MF

Gornet reported a mean operative time of 82.6 minutes, or 58 minutes per level. Estimated blood loss was about 50 cc.

Data revealed significant mean improvements from baseline in the Neck Disability Index (NDI), and neck and arm pain for both workers’ compensation and non-workers’ compensation patients at all time intervals. At 12 months, mean improvements in NDI scores were 29.5 points for workers’ compensation patients and 34.9 points for non-workers’ compensation patients; at 24 months, improvements were 29.7 for workers’ compensation and 32.9 for non-workers’ compensation patients; and at 36 months, 42.1 for workers’ compensation and 34.9 for non-workers’ compensation patients. There were no significant differences between groups.

Ninety percent of patients in both groups who were past their 6-week follow-up had received medical release to work.

“If we look at the overall mean improvement in scores and NDI, which is the benchmark, you see statistically similar improvement compared with preop and fairly robust mean improvement,” Gornet said. “Appropriately selected workers’ compensation patients with symptomatic cervical disc disease treated at one or more levels may be effectively treated and ultimately released back to work.” – by Tina DiMarcantonio

Reference:

Gornet MF. Clinical outcomes after cervical disc arthroplasty for workers’ compensation patients. Paper #530. Presented at SpineWeek 2012. May 28-June 1. Amsterdam.

Matthew F. Gornet, MD, can be reached at the Spine Research Center, Orthopedic Center of St. Louis, 14825 N. Outer Forty Rd., Chesterfield, MO 63017; email: mfgspine@gmail.com.

Disclosure: Gornet has no relevant financial disclosures.