Lumbar Diskography and Failed Back Syndrome in Patients Receiving Workers' Compensation.

Abstract

Lumbar diskography (LD) is frequently used in the evaluation of patients with degenerative disk disease and diskogenic low back pain. Its safety and diagnostic accuracy are a topic of debate. No study has evaluated the efficacy of LD within the clinically distinct workers' compensation population. Within this setting, the authors wished to determine the effect of undergoing LD before diskogenic fusion on rates of postoperative failed back surgery syndrome (FBSS). Also, the authors compared opioid analgesic use between patients undergoing LD and patients not undergoing LD. ICD-9 diagnoses and CPT procedural codes were used to identify 1591 patients from the Ohio Bureau of Workers' Compensation who underwent diskogenic fusion between 1993 and 2013. A total of 682 patients underwent LD before fusion, which formed the LD group, with the remaining 909 patients as controls. The authors used a multivariate logistic regression analysis while correcting for relevant covariates. Diskography before fusion was a positive predictor of postoperative FBSS (P=.04; odds ratio, 1.44). The rate of FBSS was 13.9% of the LD group and 8.8% in the control group. Postoperatively, the LD group was supplied with a significantly higher daily opioid analgesic load (P=.04) for an average of 130 additional days (P<.01). Additional predictors of FBSS included the ability to remain at work within 1 week of index fusion (P=.02; odds ratio, 0.54), male sex (P=.03; odds ratio, 1.51), preoperative narcotic use for more than 1 year (P=.02; odds ratio, 1.53), and fusion technique (P=.03). Diskography should ideally help identify good candidates for lumbar fusion. However, the authors' study raises significant concerns regarding LD's current role within the workers' compensation population.