Prognosis Failed back syndrome

ct scan showing post operative scarring , arachnoiditis.

in groundbreaking canadian study, waddell et al. reported on value of repeat surgery , return work in worker s compensation cases. concluded workers undergo spinal surgery take longer return jobs. once 2 spinal surgeries performed, few if ever return gainful employment of kind. after 2 spinal surgeries, people in worker s comp system not made better more surgery. worse after third surgery.

episodes of pain associated on job injuries in worker s compensation setting of short duration. 10% of such episodes not simple, , degenerate chronic , disabling pain conditions, if surgery not performed.

it has been hypothesized job dissatisfaction , individual perception of physical demands associated increased time of recovery or increased risk of no recovery @ all. individual psychological , social work factors, worker-employer relations associated time , rates of recovery.

a finnish study of return work in patients spinal stenosis treated surgery found that: (1) none of patients had retired before operation returned work afterward. (2) variables predicted postoperative ability work women were: being fit work @ time of operation, age < 50 years @ time of operation, , duration of lumbar spinal stenosis symptoms < 2 years. (3) men, these variables were: being fit work @ time of operation, age < 50 years @ time of operation, no prior surgery, , extent of surgical procedure equal or less 1 laminectomy. women s , men s working capacity not differ after lumbar spinal stenosis operation. if aim maximize working capacity, then, when lumbar spinal stenosis operation indicated, should performed without delay. in lumbar spinal stenosis patients > 50 years old , on sick leave, unrealistic expect return work. therefore, after such extensive surgical procedure, re-education of patients lighter jobs improve chances of these patients returning work.

in related finnish study, total of 439 patients operated on lumbar spinal stenosis during period 1974-1987 re-examined , evaluated working , functional capacity approximately 4 years after decompressive surgery. ability work before or after operation , history of no prior surgery variables predictive of outcome. before operation 86 patients working, 223 patients on sick leave, , 130 patients retired. after operation 52 of employed patients , 70 of unemployed patients returned work. none of retired patients returned work. ability work preoperatively, age under 50 years @ time of operation , absence of prior surgery predicted postoperative ability work.

a report belgium noted patients reportedly return work average of 12 16 weeks after surgery lumbar disc herniation. however, there studies lend credence value of earlier stimulation return work , performance of normal activities after limited discectomy. @ follow-up assessment, found no patient had changed employment because of or leg pain. sooner recommendation made return work , perform normal activities, more patient comply. patients ongoing disabling conditions have low priority return work. probability of return work decreases time off work increases. true in belgium, 20% of individuals did not resume work activities after surgery disc herniation of lumbar spine.

in belgium, medical advisers of sickness funds have important role legally in assessment of working capacity , medical rehabilitation measures employees fitness work jeopardized or diminished health reasons. measures laid down in sickness , invalidity legislation. in accordance principle of preventing long-term disability. apparent authors experience these measures not adapted consistently in medical practice. of medical advisers focusing purely on evaluation of corporal damage, leaving little or no time rehabilitation efforts. in many other countries, evaluation of work capacity done social security doctors comparable task.

in comprehensive set of studies carried out university of washington school of medicine, determined outcome of lumbar fusion performed on injured workers worse reported in published case series. found 68% of lumbar fusion patients still unable return work 2 years after surgery. in stark contrast reports of 68% post-op satisfaction in many series. in follow-up study found use of intervertebral fusion devices rose rapidly after introduction in 1996. increase in metal usage associated greater risk of complication without improving disability or re-operation rates.