Surgical Outcomes Associated with a Minimally Invasive Lumbar Diskectomy in Workman’s Compensation Patients

Presented at SMISS Annual Forum 2014
By Anton Jorgensen MD
With Kern Singh MD, Sreeharsha Nandyala BA, Alejandro Marquez-Lara MD, Islam Elboghdady , Eric Sundberg MD, Abbas Naqvi BS, Hamid Hassanzadeh MD, Khaled Aboushaala MD, Andrew Park MD,

Disclosures: Anton Jorgensen MD None Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th, Sreeharsha Nandyala BA None, Alejandro Marquez-Lara MD None, Islam Elboghdady None, Eric Sundberg MD None, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Khaled Aboushaala MD None, Andrew Park MD None,

Introduction:
Anecdotal evidence suggests that patients with WC insurance are associated with worsened outcomes following spine surgery. However, there is paucity of data that confirms this assumption, particularly in the setting of a minimally invasive (MIS) lumbar diskectomy.

Aims/Objectives:
To assess the surgical outcomes associated with a 1 and 2 level minimally invasive (MIS) lumbar diskectomy in patients with Workman’s Compensation (WC) insurance.

Methods:
A retrospective analysis of 251 patients who underwent a primary 1 and 2 level lumbar diskectomy between 2007-2013 was performed. The patients were separated into two groups based upon the primary payor status (Workmans’ Comp vs non-Workman’s Comp). Patient demographics, comorbidity Index (CCI), intraoperative parameters, postoperative outcomes postoperative complications were assessed. Statistical analysis was performed with independent sample T tests for continuous variables and Chi-square analysis for categorical data. An alpha level of <0.05 denoted statistical significance.

Results:
There were 251 patients who underwent an MIS diskectomy of which 97 (38.6%) carried WC as their primary payor. There was a greater proportion of non-Caucasians and males within the WC cohort. The WC cohort also demonstrated a higher body mass index (BMI: 31.5±6.6 vs 291±6.6 kg/m2) than non-WC patients. The patient’s age, smoking status, comorbidity burden (CCI), and pre-operative visual analogue scale (VAS) scores were comparable between cohorts. In addition, the mean procedural time, estimated blood loss (EBL), hospital length of stay, and the rate of total complications were similar. However, WC patients reported significantly higher postoperative VAS scores at 6 months (3.7±3.3 vs 1.9±2.5, p<0.05) and demonstrated higher rates of revision/reoperation (24.7% vs 7.8%, p<0.05) when compared to non-WC patients.

Conclusions:
Patients with Workman’s compensation claims represent a challenging patient population for all spine surgeons. In this analysis, patients who underwent an MIS lumbar diskectomy reported significant postoperative clinical improvement. However, the WC cohort demonstrated a higher rate of revision/reoperation and less pain relief when compared to their non-WC counterparts.