• Erik Y Tye, Joshua Anderson, Arnold Haas, Rick Percy, Stephen T Woods, and Nicholas Ahn.
• *Case Western Reserve University School of Medicine, Cleveland, OH, USA †Department of Orthopaedics, University Hospitals Case Medical Center, Cleveland, OH, USA ‡Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA §Ohio Bureau of Workers' Compensation, Columbus, OH, USA.
• Spine. 2016 Nov 9.

Study DesignRetrospective cohort study.ObjectiveTo compare outcomes in Workers' compensation (WC) subjects receiving decompression alone versus decompression and fusion for the indication of degenerative spinal stenosis (DLS) without deformity or instability.Summary Of Background DataThe use of a fusion procedure during lumbar decompression for DLS alone remains controversial. We hypothesize that WC subjects receiving fusion and decompression will return to work less and incur greater medical costs compared to subjects receiving decompression alone.Methods364 Ohio WC subjects were identified who underwent primary decompression (DC) or primary decompression and fusion (DC + F) for DLS alone between 1993-2013. Our primary outcome was if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for more than 6 months. A number of secondary outcomes were collected and analyzed.ResultsThe DC cohort had a significantly higher RTW rate [36% (83/227) vs. 25% (54/212); p = 0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that fusion with operative decompression remained a significant negative predictor of RTW status (p = 0.04; OR:0.58, 95% CI:0.34-0.99). Within the DC cohort, the rate of post-operative instability and subsequent fusion was 8%. Furthermore, subjects that received an adjunctive fusion cost the Ohio BWC on average, $46,115 more in costs accrued over 3 years after their index surgery compared to subjects that received a decompression alone.ConclusionsOverall, fusion with decompression had a significantly negative impact on clinical outcomes in WC subjects with DLS. These results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscores the need to strongly reevaluate the use of fusion for DLS without instability in the WC population.Level Of Evidence3.

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