Yes, workers comp covers lumbar fusion for degenerative discs if its work-related. Fusion surgery does have a record of success according to a recent medical journal article in the Journal of Neurosurgery: Spine Jul 2014 / Vol. 21 / No. 1 / Pages 54-61. Many injured workers in Wisconsin with lumbar disc injuries are seen by independent medical examiner, an IME doctor, who says they have degenerative disc disease that is not work related. The insurance adjuster will deny that the injured worker is an appropriate candidate for lumbar fusion surgery. While that may be the case, what if the employee’s treating surgeon is recommending a PLIF, ALIF or TLIF for work-related lumber spinal stenosis or disc degeneration? There are a significant number of recent studies published that continue to support the utility of lumbar fusion for patients presenting with stenosis and spondylolisthesis.
PLIF stands for Posterior Lumbar Interbody Fusion. In this fusion technique, the vertebrae are reached through an incision in the patient’s back (posterior), this is the most common lumbar fusion surgery we see in worker’s compensation cases. TLIF stands for Transforaminal Lumbar Interbody Fusion which is more from the side of the spinal and is generally less traumatic to the spine. ALIF stands for Anterior Lumbar Interbody Fusion, similar to PLIF, however it is done from the front (anterior) of the body.
Frequently we see injured workers with a spinal stenosis or degenerative disc disease diagnosis, occasionally called degenerative spondylolisthesis. Spondylolisthesis is forward displacement of one vertebrae over another. Surgical decompression (disc removal) and fusion is recommended as an effective treatment alternative for symptomatic stenosis associated with a degenerative spondylolisthesis in patients who desire surgical treatment. If medically recommended, this should be covered under worker’s compensation if the spondylolisthesis is caused in part by the worker’s job duties over time. The important factors in whether the spinal stenosis or disc degeneration is work-related, is the duration, frequency and exertion levels of the repetitive job duties causing the back injury.
At McCormick Law Office in Milwaukee, Wisconsin our attorneys and paralegals believe an injured worker should rely only on health care professionals for medical advice. Also, we strongly believe that an injured worker should make the decision whether to have lumbar back fusion surgery only based on medical considerations and not legal issues. The literature demonstrates that patients get the best results from fusion surgery when there is a solid arthrodesis, the connection between the two fused vertebrae. While there are pre-surgery steps that can be taken to help make for a strong fusion, the doctors and therapists often recommend reasonable permanent work restrictions so that the solid fusion stays that way.