Date of Award:

5-2012

Document Type:

Dissertation

Degree Name:

Doctor of Philosophy (PhD)

Department:

Psychology

Committee Chair(s)

M. Scott DeBerard

Committee

M. Scott DeBerard

Committee

Susan L. Crowley

Committee

Michael P. Twohig

Committee

JoAnn T. Tschanz

Committee

Edward M. Heath

Abstract

Over the past 2 decades, lumbar fusion surgeries performed in the United States have increased dramatically, particularly for compensated workers. Costs for these procedures have also risen substantially in the past decade, primarily due to the use of more sophisticated surgical devices such as interbody fusion cages. While surgical instrumentation and technology may improve the rates of solid bony vertebral fusion, overall improvements in quality of life and pain outcomes related to this new technology are still inconclusive.

In collaboration with the Workers Compensation Fund of Utah (WCFU) and Utah State University (USU), a psychology professor, Dr. M. Scott DeBerard, and a USU doctoral student, Jessica Gundy, proposed a study examining multiple outcomes of lumbar fusion surgery in a sample of injured workers. The projects main purpose was to evaluate several biological, social, and, psychological outcomes among injured workers undergoing lumbar fusion in terms of quality of life, fusion rates, patient satisfaction, and disability. Another important aim was to evaluate how outcomes have changed since the advent of new spine surgical fusion technology.

Findings from our project show that over the past decade, overall fusion rates have increased significantly. However, despite enhanced fusion rates, injured workers who have undergone lumbar fusion in Utah demonstrated somewhat worse outcomes than those documented a decade ago. Specifically, the present study demonstrated significant increases in disability rates and reported decreases in functional capacity and poor quality of life. While these findings do not support the position that compensated workers cannot benefit from lumbar fusion, they do highlight the importance of medical providers and surgeons to use more discretion when recommending lumbar fusion as a treatment option for injured workers. Further, there appear to be some strong incentives for surgeons to perform lumbar fusion with surgical devices that do not have adequate evidence to support their utility. These issues are imperative when considering both the financial costs associated with these surgeries, as well as the human costs such as pain, suffering, time away from family, job loss, and overall disability.

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This work made publicly available electronically on April 12, 2012.

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