Lumbar fusion performed among injured workers has dramatically increased over the past two decades, coinciding with the increased use of more advanced surgical technology. Despite recent changes in how this surgery is performed, few outcome studies have been conducted, particularly among workers compensation populations. In prior studies, several biopsychosocial risk factors were found to be predictors of functional outcomes of lumbar fusion. Considering the recent changes in lumbar fusion surgery, there is a need to identify how patient outcomes have changed among injured workers, and whether a biopsychosocial model continues to be predictive of outcomes. The current study aimed to address multidimensional patient outcomes associated with lumbar fusion and examine the relationship between presurgical biopsychosocial variables and outcomes by testing the predictive efficacy of a multiple variable model. Injured workers (N = 245) who underwent their first lumbar fusion between 1998 and 2007 were included in a retrospective-cohort study performed in two phases that involved coding presurgical information documented in patient medical charts in the Worker's Compensation Fund of Utah computer database (Phase 1) and administering a telephone outcome survey with patients at least 2 years post-surgery (Phase 2). Of the total sample, 45% (n = 110) of patients were contacted and completed follow-up outcome surveys on several measures of patient satisfaction, quality of life, fusion status, dysfunction level, disability status, pain, and general physical and mental health functioning. Results revealed injured workers reported a solid fusion rate of 89.0%, disability rate of 28.7%, and a poor outcome rate of 57.1%. Multiple linear regression analyses demonstrated an eight variable model was a statistically significant predictor of multiple patient outcomes. Involvement of a nurse case manger, vocational rehabilitation, and litigation at the time of fusion were the most prominent predictors across outcome measures, while age and depression history showed modest prediction of outcomes. Prior back operations, number of vertebral levels fused, and type of instrumentation showed no statistically significant prediction of outcomes. Results were evaluated and compared to prior lumber fusion studies on injured worker and fusion outcome literature, in general. Specific implications for our findings and limitations associated with this study were addressed.

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La révolution industrielle du XIXème siècle, marquée par la création des grandes usines, a entraîné une mutation de la classe laborieuse constituée d’ouvriers dont les conditions de travail étaient d’une dureté que l’on peine à imaginer aujourd’hui. L’état de santé des ouvriers représentait pourtant un enjeu économique et politique d’une grande importance. L’Etat a, en conséquence, produit une législation tutélaire visant à protéger les corps des travailleurs : une législation industrielle devenue droit du travail, dans le cadre de ce plus vaste ensemble que l’on dénomme le droit social. Le droit du travail assure un équilibre entre les acteurs des relations du travail. Il est, essentiellement, un droit de compromis à des fins de pacification des relations sociales, un compromis social entre les intérêts des entreprises et ceux des travailleurs salariés. Le « droit social », qui recouvre, au moins, le droit du travail et le droit de la sécurité sociale, est à la fois un droit de protection et un droit de réparation des atteintes portées aux corps des salariés par le travail. L’homme au travail a longtemps été considéré comme une machine de production et le corps perçu uniquement du point de vue mécanique. Mais le corps est le substratum de la personne ; il n’est pas une chose : il est la personne protégée par des règles pénales, les règles composant le droit civil des personnes – au lieu de relever du droit des biens – et celles qui consacrent et garantissent ce que l’on appelle volontiers, aujourd’hui, les droits et libertés fondamentaux. Aujourd’hui, le travail, activité productive, est beaucoup plus diversifié que celui du XIXème siècle. Les conditions sociales et du travail ont évolué avec le droit du travail qui est bien différent d’alors. Les risques professionnels sont différents et l’homme au travail, considéré comme une personne à part entière, peut subir des atteintes à sa santé physique et mentale. Si le droit du travail poursuit les buts partiellement antagonistes de préserver, à la fois, le capital et le travail, la question est de savoir quels instruments juridiques visent à prémunir les salariés des atteintes à leur intégrité physique et mentale que pourrait provoquer le travail. Celui-ci étant, cependant, source d’accidents et de maladies, il s’agit de connaître les outils utilisés par le droit positif afin de permettre la réparation de ces atteintes. / The industrial revolution of the nineteenth century saw the creation of large factories, leading to a change in the living and working conditions for the proletariat, whose working conditions were more difficult than we could imagine today. Worker's health became an economic and political issue of great importance. The State, therefore, passed guardianship legislation to protect workers' health: the industrial legislation become labor law, a subset of broader social laws. The labor law provided a balance between the actors of labor relations. It was essentially a law compromise for the purpose of pacification of social relations, a social compromise between the interests of business and those of employees. "Social law", which incorporates both the labor law and the social welfare law, is composed of laws to protect and rules to govern awards for damages for injuries incurred in the workplace. The working man has long been considered a production machine viewed only from a mechanical point of view, but the body is the substratum of the person; it is not a thing. A person is protected under criminal law and civil law, not property law; what we now call fundamental rights and freedoms. In today's workforce, productive activity is much more diverse than in the Nineteenth Century. Social and labor conditions have evolved, as has labor law. Occupational hazards are different and the working man, considered as a whole person, may suffer damage to his physical and mental health. If labor law continues tries to encourage capital gain and workforce safety at the same time, how effective are the regulations that are in place to protect workers from physical harm. Workplace injuries and illnesses will occur, so it becomes important to know the tools of french positive law created to insure reparations in the instances.