Abstract
Aim
To compare spinal outcome measures between patients reviewed for medico-legal compensation claims relating to perceived injury at work to those having sustained serious structural injury in the form of unstable thoraco-lumbar fractures requiring internal fixation.
Method
Two consecutive cohorts of 23 patients with healed spinal fractures and 21 patients with a perception of work related soft tissue injury were compared. Patient demographics and a range of outcome measures including Oswestry Disability Index (ODI), Low Back Outcome score (LBOS), Modified Somatic Perception (MSP) and Modified Zung Depression (MZD) indices were measured.
Results
23 patients (8F; 15M) with spinal fractures (group 1) of average age 42 years (range 22-66) were followed up for a mean of 41 months (range 14-89, SD 23.3) post trauma and compared to 21 patients (6 females; 15 males) with self reported back pain (group 2) of average age 47 years (range 37-63), mean time since perceived injury of 42 months (range 12-62, SD 14.5). Both groups were comparable in terms of age and sex (P = 0.254 and 0.752 respectively).
The average ODI was 28% (SD 18.5) compared to 52% (SD 17.1) in group 1 and 2 respectively (P value: 0.000087); LBOS 40 Vs 20 (P=0.000189); MSP 4 Vs 10 (0.01069); and MZD 20 Vs 36 (P=0.000296).
Conclusion
Despite high energy trauma and significant structural damage to the spine, post-traumatic patients had better spinal outcome scores in all measures (ODI, LBO, MSP, MZD). This thereby defies 8 of the 9 Bradford Hill criteria of causation. The reasons for such differences are primarily psychosocial. Addressing obstacles to recovery may improve outcomes. There is no ‘dose-response’ curve to functional outcomes. In fact, uniquely the disability seems greater in the lower energy injury which is unique in trauma care.
