Surgical Survivorship of Minimally Invasive Lumbar Laminectomy Associated with Workman’s Compensation Claims

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

Disclosures: Islam Elboghdady 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, Eric Sundberg MD None, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Andrew Park MD None,

Introduction:
Intractable lower back and leg pain from spinal stenosis is a common complaint in workman’s compensation (WC) patients. The surgical survival associated with minimally invasive (MIS) lumbar laminectomy procedures in this challenging patient population has not been previously described.

Aims/Objectives:
To assess the surgical survivorship associated with a minimally invasive 1 or 2 level lumbar laminectomy in patients with workman’s compensation claims.

Methods:
A retrospective review of 106 patients who underwent a primary 1 or 2 level lumbar laminectomy between 2007-2013 was performed. Only MIS procedures, and patients with a documented one-year follow up visit were included for the analysis. The selected cohort was stratified based upon primary payor status (WC and non-WC) and assessed with regards to demographics, Charlson comorbidity index (CCI), and body mass index (BMI). A Kaplan-Meier analysis was performed to assess the incidence and prevalence of revision surgeries at 12-months. Differences in survival distribution between the two cohorts were identified with the Log-Rank comparison test and a p-value of <0.05 was utilized to denote statistical significance.

Results:
Of the 73 patients included for analysis, 15 (20.5%) carried WC as the primary insurance. WC patients were younger (45.7±9.6 vs 59.9±14.5, p<0.05), and demonstrated a reduced comorbidity burden (CCI: 1.50±1.65 vs 4.03±1.82, p<0.05) compared to non-WC patients. Overall 6 (7.8%) patients required a revision surgery for persistent or worsening symptoms within 12-months of the index lumbar laminectomy. Kaplan-Meier analysis predicted a lower one-year survival in the WC cohort compared to the non-WC cohort (80.0% (n=12/15, mean survival in days: 340.1) vs 94.8% (n=55/58, mean survival in das356.2). However, comparison analysis demonstrated that the differences in survival distributions were not statistical significant. (Chi-square 3.5, p=0.06). The types of revision surgery (arthrodesis vs decompression, p=1.0) were similar between the two cohorts.

Conclusions:
Although not statistically significant, patients with WC claims demonstrated a higher incidence and prevalence of revision surgery after MIS lumbar laminectomy procedures compared to non-WC patients. The long-term survival of MIS lumbar laminectomies in WC patients is yet to be determined, however, the findings in this study should be considered when discussing patient expectations in this particular population.