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Vertebroplasty and Return to Work for Thoracolumbar Fractures Within the Workers' Compensation Population.
Spine 2017 July 2
STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: Analyze efficacy of vertebroplasty and its affect on return to work (RTW) in a workers' compensation (WC) population SUMMARY OF BACKGROUND DATA.: Vertebroplasty remains a controversial treatment modality for vertebral compression fractures (VCFs). No studies have analyzed use of vertebroplasty in the clinically distinct WC population.
METHODS: A total of 371 Ohio WC subjects were identified who sustained VCFs and were treated with either vertebroplasty or conservative medical therapy between 1993 and 2013 using Current Procedural Terminology procedural and International Classification of Diseases, Ninth Revision diagnosis codes. Subjects with a prior smoking history, prior thoracolumbar surgery or comorbidities, or underwent decompression and/or fusion within 3 months after injury were excluded. Forty-six subjects had undergone vertebroplasty within 1 year of injury and were therefore included in the vertebroplasty group. The remaining 325 subjects received spinal orthosis and formed the control group. The primary outcomes were whether subjects returned to work at early and late time points. Early RTW was defined as returning to work within 3 months and remaining at work for more than 6 months of the following year. Late RTW was defined as returning to work within 2 years and remaining at work for more than 6 months of the following year. Secondary outcomes included opioid use, all-cause mortality, and additional VCFs.
RESULTS: Approximately 37% (17/46) of vertebroplasty group made an early RTW, compared with 35.4% (115/325) of control group (P = 0.835). Regarding late RTW, only 54.3% (25/46) of vertebroplasty group made a sustainable RTW, compared with 70.8% (230/325) of subjects in control group (P = 0.025). In addition, the vertebroplasty group was associated with significantly higher postoperative opioid use.
CONCLUSION: Vertebroplasty may not be an effective treatment modality for VCFs in the WC population when RTW is the primary goal.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: Analyze efficacy of vertebroplasty and its affect on return to work (RTW) in a workers' compensation (WC) population SUMMARY OF BACKGROUND DATA.: Vertebroplasty remains a controversial treatment modality for vertebral compression fractures (VCFs). No studies have analyzed use of vertebroplasty in the clinically distinct WC population.
METHODS: A total of 371 Ohio WC subjects were identified who sustained VCFs and were treated with either vertebroplasty or conservative medical therapy between 1993 and 2013 using Current Procedural Terminology procedural and International Classification of Diseases, Ninth Revision diagnosis codes. Subjects with a prior smoking history, prior thoracolumbar surgery or comorbidities, or underwent decompression and/or fusion within 3 months after injury were excluded. Forty-six subjects had undergone vertebroplasty within 1 year of injury and were therefore included in the vertebroplasty group. The remaining 325 subjects received spinal orthosis and formed the control group. The primary outcomes were whether subjects returned to work at early and late time points. Early RTW was defined as returning to work within 3 months and remaining at work for more than 6 months of the following year. Late RTW was defined as returning to work within 2 years and remaining at work for more than 6 months of the following year. Secondary outcomes included opioid use, all-cause mortality, and additional VCFs.
RESULTS: Approximately 37% (17/46) of vertebroplasty group made an early RTW, compared with 35.4% (115/325) of control group (P = 0.835). Regarding late RTW, only 54.3% (25/46) of vertebroplasty group made a sustainable RTW, compared with 70.8% (230/325) of subjects in control group (P = 0.025). In addition, the vertebroplasty group was associated with significantly higher postoperative opioid use.
CONCLUSION: Vertebroplasty may not be an effective treatment modality for VCFs in the WC population when RTW is the primary goal.
LEVEL OF EVIDENCE: 3.
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