Do Spinal Fusions Necessarily Result In Poorer Therapeutic Outcomes?

Controversy exists over the relationship between spinal fusion surgery and successful therapeutic outcomes. Common problems include unstandardized outcomes, ignoring the impact of the medico-legal system, and a paucity of investigations going beyond the surgical procedure itself. The present study compared patients who received spinal fusions against patients who did not, within the setting of a tertiary rehabilitation program (i.e. functional restoration) for work-related chronic disabling occupational spinal disorders. Program completers were prospectively evaluated on several objective one-year post-rehabilitation outcomes, including occupational status and level of healthcare utilization. The non-fusion group (N = 2,295) had a statistical advantage over the fusion group (N = 299) on several one-year outcomes. However, these differences were not significant when adjusted for patient demographic factors and psychosocial comorbidity. Significant risk factors for poorer outcomes (e.g. opioid dependence disorder, depressive symptoms) were identified and discussed within the context of prior research on chronic pain and disability.