A new study published in Spine examines workers compensation patients with degenerative spinal stenosis. The aim of this study was to compare outcomes in Workers’ compensation (WC) subjects receiving decompression alone versus decompression and fusion for the indication of degenerative spinal stenosis (DLS) without deformity or instability.

The 364 patients included in the study from the Ohio Workers Compensation database either underwent primary decompression or primary decompression and fusion between 1993 and 2013. The primary outcome to be measured was if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for more than 6 months. A number of secondary outcomes were collected and analyzed.

The study authors found:

1. The decompression only patients reported a higher return to work rate – 36 percent, compared with 25 percent in the fusion group.

2. Fusion was a negative predictor of return to work status, as demonstrated by a logistic regression model.

3. The rate of postoperative instability and subsequent fusion among the decompression-only patients was 8 percent.

4. Subjects who received an adjunctive fusion cost of the Ohio BWC on average, $46,115 more in costs accrued over 3 years after their index surgery compared with subjects who received a decompression alone..

5. The study authors concluded fusion had a “significantly negative impact” on the outcomes for workers compensation patients. “The results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscore the need to strongly reevaluate the use of fusion for Degenerative Lumbar Stenosis without instability in the WC population.”