Decompression Versus Decompression and Fusion for Degenerative Lumbar Stenosis in a Workers’ Compensation Setting

Tye, Erik Y. BA*,†; Anderson, Joshua MD‡ et al Spine July 2017

Objective. 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.

Summary of Background Data. The use of a fusion procedure during lumbar decompression for DLS alone remains controversial. We hypothesize that WC subjects receiving fusion and decompression will return to work less and incur greater medical costs than subjects receiving decompression alone.

Methods. Three hundred sixty-four Ohio WC subjects were identified  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.

Conclusion. Overall, fusion with decompression had a significantly negative impact on clinical outcomes in WC subjects with DLS. These results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscore the need to strongly reevaluate the use of fusion for DLS without instability in the WC population.