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I hurt my back at work and just haven't gotten better. I really love my job and want to get back to it. My doctor has suggested a one-level spinal fusion (L45). What are my chances for full recovery with and without the operation?

Odds ratios for workers' comp (WC) patients with back pain are extremely difficult to predict. Studies show varying results. There is a general trend toward poor results after spinal fusion for WC patients.

In a preliminary study from Ohio, out of 725 WC patients who had lumbar fusion, only six per cent were back on the job after a full year. Almost one-third of the group ended up having a second operation. And the use of narcotics for pain control was very high (90 per cent).

Doctors aren't sure what is the problem. Perhaps it's just part of the WC dilemma. Or maybe there's something about the surgery itself that leads to such a poor result. Social, psychologic, and behavioral factors can't be ignored.

Smaller studies report disability rates as high as 25 per cent after a single-level fusion. Disability rates went up for WC patients having two- or three-level fusions. There was 100 per cent disability reported for the group having a three-level fusion.

It's possible that results improve over time. Longer studies are needed to report the results of spinal fusion after two, five, and 10 years. Your motivation to get back to the job may also be a positive factor in your own case.

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