New Rules for Ohio Worker's Compensation: 60 Days of Conservative Treatment Before Fusion Surgery

August 08, 2017 Kiro Coffee

The Ohio Bureau of Worker's Compensation recently released new rules for injured workers considering a spinal fusion surgery. Starting January, 1 2018 the Bureau will only cover fusion surgeries if certain criteria are met. Those criteria include:

1. Conservative care.

The injured worker must have had at least 60 of conservative care for low back pain, with an emphasis on:

  • Physical reconditioning
  • Avoidance of opioids, when possible
  • Avoidance of provider catastrophizing the explanation of lumbar MRI findings
  • Relative rest/ice/heat
  • Anti-inflammatories
  • Pain management / physical medicine rehabilitation program
  • Chiropractic / osteopathic treatment
  • Physical medicine treatment
  • Interventional spine procedures / injections

2. The operating surgeon requesting authorization for lumbar fusion surgery must have personally evaluated the injured worker on at least two occasions prior to requesting authorization for lumbar fusion surgery.

3. The injured worker must have undergone a comprehensive evaluation, coordinated by both the injured worker's physician of record or treating physician and the operating surgeon, with proper testing and documentation.

Factors also included in the rules include previous spinal surgeries, opioid use counseling, and after care instructions. Patients, treating physician, and surgeon all will also have to sign a document titled "What BWC Wants You to Know About Lumbar Fusion Surgery" detailing the current literature on spinal fusion surgery outcomes and what to expect. Some highlights from this article include:

General Lumbar Fusion Outcomes

  1. The chance of a an injured worker no longer being disable 2 years later after lumbar fusion is 32%.

  2. More than 50% of workers who receive lumbar fusion through the Washington workers’ compensation program felt that both pain and functional recovery were no better or were worse after lumbar fusion.

  3. Smoking at the time of fusion greatly increases the risk of failed fusion

  4. Pain relief, even when present is NOT likely to be 100%.

  5. The use of spine stabilization hardware (metal devices) in Washington workers nearly doubled the chance of having another surgery.

  6. Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in work comp setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor return to work status.

Ohio Specific Lumbar Fusion Outcomes Study: (2 year follow-up – 1450 total patients)

  1. Back pain patients treated with fusion were able to return to work (activity) only 26% of the time, workers treated non-surgically were able to return to work (activity) 67% of the time.

  2. Re-operation rate was 27% in fused patients

  3. Complications occurred in 36% of fused patients

  4. Narcotic use increased 41% in fused patients, and continued for over 2 years in 76% of fused patients

  5. 17 of the fused patients died during the course of the study and11 non-surgical patients

  • National/International Lumbar Fusion Statistics

    1. Surgical fusion outcomes are NOT better than cognitive therapy and exercise

    2. Surgical fusion for previous herniated disk is NOT better than non- operative treatment

    3. Surgical satisfaction was reportedly high even in injured workers with ongoing pain and no improvement in function observed

    4. Some patients described less pain, improvement of 1 or 2 points on a 10 point pain scale, but any functional benefit of having a fusion was not demonstrated

  • Opioid use has been associated with significant long term morbidity and mortality in both surgical and non-surgical patients. Back pain patients are at risk for long term opioid use. Fusion patients have greater narcotic/opioid usage than non-operative patients.

It's obvious the Ohio Bureau of Worker's Compensation is strongly advising against having lumbar fusion surgeries unless it is absolutely medically necessary. The outcomes of lumbar fusion surgeries are less than stellar and conservative management has taken precedence in management of the injured worker.  





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