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Abstract: Early Predictors of Lumbar Spine Surgery

January 29, 2013

A recent study (abstract below) provided documentation of chiropractic care as a first option for back pain relief and surgical avoidance. “Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State,” (Spine; 12.12.2012) observed reduced odds of surgery for those under age 35, women, Hispanics and those whose first provider was a chiropractor.


In total, 42.7 percent of workers who initially visited a surgeon underwent surgery, in contrast to only 1.5 percent of those who first consulted a chiropractor. This important study was conducted by a collaboration of prestigious institutions, including Geisel School of Medicine at Dartmouth College, University of Washington School of Public Health, University of Washington School of Medicine, Ohio State University College of Public Health and the Washington State Department of Labor and Industries. Back injuries are the most prevalent occupational injury in the U.S., and care is commonly associated with one of the most costly treatments – spine surgery. Chiropractic is clearly the most appropriate first treatment option for patients with back pain, and this study confirms the value.


An additional study, “Health Maintenance Care in Work-Related Low Back Pain and Its Association with Disability Recurrence,” (Journal of Occupational and Environmental Medicine; 4.1.2011) also examined chiropractic care for occupational back injuries and found similar outcomes. The study reported for work-related nonspecific low back pain, chiropractic care was associated with a lower disability recurrence, when compared to treatment by other medical interventions. Overall, chiropractic patients illustrated consistently better outcomes, less use of opioids, and had fewer surgeries, with lower medical expenses.



Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State.


Benjamin J. Keeney, PhD,# Deborah Fulton-Kehoe, PhD, MPH,† Judith A. Turner, PhD,∫^  Thomas M. Wickizer, PhD,‡ Kwun Chuen Gary Chan, PhD,◊* and Gary M. Franklin MD, MPH¶†*


Source

From the Department of #Orthopaedics, Geisel School of Medicine at Dartmouth College; the Department of †Environmental and Occupational Health Sciences, University of Washington School of Public Health;  the Department of ∫Psychiatry and Behavioral Sciences, University of Washington School of Medicine; the Department of ^Rehabilitation Medicine, University of Washington School of Medicine; ‡Division of Health Services Management and Policy, Ohio State University College of Public Health; the Department of ◊Biostatistics, University of Washington School of Public Health; the Department of *Health Services, University of Washington School of Public Health;  ¶Washington State Department of Labor and Industries, Olympia, WA

Abstract

Study Design. Prospective population-based cohort study Objective. To identify early predictors of lumbar spine surgery within 3 years after occupational back injury Summary of Background Data. Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury. Methods. Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers with new worker's compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The model's area under the receiver operating characteristic curve (AUC) was used to determine the model's ability to identify correctly workers who underwent surgery. Results. In the D-RISC sample of 1,885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those under age 35, women, Hispanics, and those whose first provider was a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The multivariate model's AUC was 0.93 (95% CI 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery. Conclusion. Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.