Ohio BWC New Rule Discourages Lumbar Fusion and Opioids

​The new rule requires that workers undergo at least 60 days of comprehensive conservative care, including physical therapy, chiropractic care, rest, anti-inflammatories, ice and other nonsurgical remedies, before surgical options are considered.

Researchers found that lumbar fusion surgery patients had less success than non-fusion patients. Fusion patient outcomes also include chronic opioid dependence, increased disability, chronic pain, and additional surgeries.

According to Dr. Richard Deyo, Portland, Oregon:

"The most common situation in work-related back pain is simply that patients have pain and often little in the way of actual neurological injury, usually not fractures of the spine, but simply back pain, and in that situation, it makes a lot of sense to try aggressive nonsurgical therapy first," Dr. Deyo said. "This is true for patients who have back pain alone and even for patients who have a herniated disk in most cases. It's worth waiting that length of time because patients will improve over that length in time without surgery."

Many patients who undergo surgery still end up taking long-term opioid treatment after surgery, he said. Along with the bureau's recommendation, spinal manipulation therapy, acupuncture and cognitive behavior theory are other forms of possible nonsurgical treatment.