Comparing outcomes of anterior cervical discectomy and fusion in workman's versus non–workman's compensation population

Abstract Background context: Anterior cervical discectomy and fusion (ACDF) is an accepted surgical procedure to treat degenerative conditions, including disc herniations and spinal stenosis. The literature on lumbar spine surgery reports that patients with a workman's compensation claim have less successful clinical results. Regarding the cervical spine, however, different conclusions have been drawn. Purpose: The purpose of this study was to directly compare the functional outcomes of ACDF in patients with and without a workman's compensation claim and to determine whether a compensation claim adversely affected the clinical outcome. Study design: This is a retrospective study examining the long-term results of ACDF in the workman's and non–workman's compensation populations. Patient sample: Eighty consecutive patients undergoing ACDF were retrospectively analyzed. The patients were divided into two groups: 30 patients in Group 1 (workman's compensation) and 50 patients in Group 2 (non–workman's compensation). The average age of Group 1 was 45 years (range, 31 to 57) and Group 2 was 45 years (range, 30 to 79). The patients were followed for an average length of 4 years (range, 2 to 7 years). Outcome measures: We evaluated the surgical results using a functional outcome scoring system (Odom's Criteria), visual analog scale and a radiographic grading scale. The questionnaire was independently administered in a standard question-answer format at the 1-year follow-up. Statistical analyses was performed using a Levene's test. Methods: All surgeries were performed by the same attending physician. A left-sided approach and Smith-Robinson fusion technique with autograft or allograft without instrumentation was used in all cases. A hard cervical orthosis was used postoperatively for 8 weeks. Radiographic examination including lateral flexion and extension views were obtained at a minimum of 12 months postoperatively. Furthermore, radiographic analysis was performed each subsequent postoperative year. The radiographs were analyzed by two independent physicians in a blind fashion for evidence of radiographic fusion. Results: At follow-up no discernible difference was noted for functional outcomes. Eighty-three percent of patients in Group 1 and 90% of patients in Group 2 noted excellent or good results. This was not statistically significant (p=.280). In Group 1, 97% of patients returned to work at an average of 18 weeks, whereas 98% of patients in Group 2 returned to work at an average of 10 weeks postoperatively. Upon radiographic evaluation, 64% of patients in Group 1 were determined to have a solid fusion (Grade 3). The fusion rate in Group 2 was 72%. This was not statistically significant. However, the fusion rate among smokers was 50%, and among nonsmokers it was 80%. This was statistically significant (p=.001). Conclusions: Workman's compensation claims did not adversely affect the functional outcome of ACDF. It should be noted that a significant increase in pseudarthroses was noted with the smoking population. Patient selection is a critical factor in determining functional outcome, with 83% good to excellent results if the pathology, clinical presentation and radiographic findings correlate