COLUMBUS, Ohio – Ohio residents with work-related back injuries, in most cases, must try remedies like rest, physical therapy and chiropractic care before turning to spinal fusion surgery and prescription painkillers under a groundbreaking new guideline that is partly meant to reduce the overprescribing of opioids but isn't sitting well with everyone.
Washington, Colorado and Minnesota already restrict injured-worker payments for the surgery, officials said, but the Ohio policy, which went into effect Jan. 1, goes further by embedding an opioid warning specifically into its surgical restriction. The state has been among the hardest hit by the overdose crisis, which many experts say stems largely from addictions to prescription painkillers that can progress into heroin use.
At issue is a procedure in which portions of the patient's spine are fused permanently to address certain conditions, including degenerative disc disease and severe chronic low back pain. Injured Ohio workers get such surgery about 600 times a year.
The new rule at the Ohio Bureau of Workers' Compensation, the nation's largest state-run injured-worker fund, requires an injured worker to undergo at least 60 days of alternative care – while avoiding opioid use, if possible – before resorting to spinal fusion surgery, with a few exceptions for the most severe back injuries. By including the opioid warning, it's a more aggressive restriction than other states that also decline to pay right away for the surgery.
Daniel Resnick, a Madison, Wisconsin-based neurosurgeon and president of the North American Spine Society, said the Ohio rule is overly broad and will result in added hurdles for those in need of spinal fusion surgery.
“Lumbar fusion works extremely well for a few things,” he said. “It doesn't work well for everything, and it doesn't work well for every patient, but in those cases where it's appropriate, this is an unsophisticated rule that's going to add an administrative burden – added time, added costs – for the patient. They'll be futzing around wasting two months rather than getting the effective treatment they need.”
But the bureau defends the decision.
Studies have shown that fewer than half of patients are able to return to work after the surgery and that it is often ineffective or followed by complications. Afterward, workers' pain oftentimes continues – or even gets worse.
“We now have better knowledge of who responds better to surgery, and we also know that some patients actually require more opioid medication after surgery than they did before surgery,” said Terrence Welsh, the Ohio injured worker bureau's chief medical officer.