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Outcomes of Disabling Cervical Spine Disorders in Compensation Injuries: A Prospective Comparison to Tertiary Rehabilitation Response for Chronic Lumbar Spinal Disorders

Wright, Anna, PhD*; Mayer, Tom G., MD; Gatchel, Robert J., PhD

Functional Restoration

Study Design. A prospective, longitudinal cohort study assessing quantitative socioeconomic outcomes of tertiary rehabilitation for chronically disabled patients with cervical spinal disorders compared with those with more common chronic lumbar spinal disorders.

Objectives. To assess 1-year socioeconomic outcomes of a worst-case cohort of consecutive patients with chronic cervical spinal disorders compared with those of patients with lumbar spinal disorders and to assess differences in an array of variables between those patients who reported any period of work during the posttreatment year and those who did not.

Summary of Background Data. Few investigators have evaluated outcomes in patients with cervical spinal disorders. None have specifically studied distinctions in socioeconomic outcomes in patients with chronic cervical spinal disorders and in patients with other spinal disorders. Reports of pain are noted to persist in a high percentage of patients with whiplash receiving compensation even 10 years after injury, but the status of work, use of health care resources, financial disputes, or recurrent injury are unknown.

Methods. A cohort of consecutive chronically disabled patients with spinal disorders (N = 1198) was assessed for prospectively collected demographic, self-report, and physical performance data. A subset of patients (n = 421) with work-related cervical spinal disorders was compared with a group with various lumbar spinal disorders (n = 777). A structured clinical interview was administered 1 year after patients entered an interdisciplinary functional restoration program.

Results. High rates of return to work and continuation of work were recorded in the cervical and lumbar spinal disorder groups, with low rates of recurrent injury, new surgery in the injured area, and use of health care resources. There were no statistically significant differences between the groups. Multivariate analyses showed several variables that differentiated between those patients who had any reported period of work during the posttreatment year versus those who did not in the cervical and the lumbar spinal disorder groups.

Conclusions. This first large cohort study of outcomes in chronically disabled patients with work-related cervical spinal disorder produced results similar to those found in tertiary functional restoration rehabilitation in chronic lumbar spinal disorders. In spite of poor outcomes reported in the literature for similar cervical and lumbar spinal disorders in patients receiving workers' compensation for disability, successful outcomes can be anticipated after effective rehabilitation, regardless of response to prerehabilitation treatment.

From the *Productive Rehabilitation Institute of Dallas for Ergonomics Research Foundation; and the Departments of †Orthopedic Surgery and ‡Psychiatry and Rehabilitation Science, University of Texas Southwestern Medical Center, Dallas, Texas.

Acknowledgment date: December 15, 1997.

First revision date: March 26, 1998.

Acceptance date: May 21, 1998.

Device status category: 1.

Address reprint requests to: Tom G. Mayer, MD; Medical Director; PRIDE Research Foundation; 5701 Maple Avenue, Suite 100; Dallas, TX 75235.

© 1999 Lippincott Williams & Wilkins, Inc.