Return to work rates of workers compensation patients with lumbar radiculopathy following epidural steroid injection

TL;DR

This study finds that only about 10% of workers with back injuries return to work after receiving epidural steroid injections, with older workers less likely to return.

Contribution

The study provides new insights into return-to-work rates after epidural steroid injections for lumbar radiculopathy in workers' compensation patients.

Findings

Only 10.4% of workers returned to work after lumbar epidural steroid injections.

Older age was associated with a lower likelihood of returning to work.

Gender and number of injections did not significantly affect return to work rates.

Abstract

Low back injury is one of the leading causes of work-related injuries, disability, and lost productivity. Patients with lumbar radiculopathy are a subgroup of patients within work related low back injury. To our knowledge, there are few studies that specifically assessed the relationship between treating radiculopathy with an epidural injection and return to duty for injured workers. Treatments such as lumbar epidural steroid injection (ESI) that potentially expedite safe return to work could have cost-saving benefits by reducing the need for spine surgery while ameliorating an injured worker's pain and suffering.

The objective of the study is to estimate the return-to-work rate in worker's compensation patients treated at a single academic site who were diagnosed with work related low back injury with lumbar radicular pain and treated with lumbar ESI.

Electronic medical record data was obtained from the University of Rochester Clinical & Translational Science Institute in a retrospective review. Patients evaluated in the departments of Physical Medicine and Rehabilitation or Orthopaedics at a tertiary care medical center from January 1, 2012 to October 31, 2023. with at least one visit for lumbar radiculopathy, lumbar spinal stenosis and lumbar disc herniation were included in the study. Return to work rates were estimated from all workers treated with a lumbar ESI. Patient age, gender and number of injections were evaluated for their effect on RTW rate.

23 of 222 patients treated with a lumbar ESI returned to work, this totaled 10.4 % of the subgroup (95 % CI: 6.7 %–15.1 %). There was insufficient evidence of an association between gender and return to work following treatment with a lumbar ESI (OR for male = 1.09, 95 % CI 0.44–2.69, p = 0.86). Similarly, there was no association between the number of injections and return to work. (OR for 3+ injections compared to 1–2 injections 0.73, 95 % CI 0.30–1.80, p = 0.49). However, we observed a decrease in likelihood of returning to work as age increases in patients treated with ESI (OR per 10 years of age = 0.51, 95 % CI 0.36–0.73, p = 0.0002).

Return to work rates in worker's compensation patients were 10.4 % after treatment with lumbar ESIs. It appears that even with treatment of lumbar ESIs, worker's compensation patients with lumbar radiculopathy had a low chance of returning to work.

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