Mining-Related Lower Back Injuries and the Compensation Process: An Injured Worker's Journey

Workers’ compensation experience in some Indigenous Northern Ontario communities

BACKGROUND: There is a dearth of research about occupational health and safety experience in Indigenous communities and compensation applications from Indigenous workers appear limited. OBJECTIVE: This qualitative descriptive study was designed to explore workers’ compensation experiences in some Canadian Indigenous communities. METHODS: A community-based participatory research approach was used to conduct focus groups (n = 25 participants) in three Northeastern Ontario (NEO) Indigenous communities and at one NEO Indigenous employment centre. Semi-structured focus group questions addressed community experience with workers’ compensation, the compensation process, and discussion of a training session about the process. Reflexive thematic analysis followed Braun and Clarke procedures. RESULTS: Discussion with study participants resulted in these themes: 1) both lack of knowledge, and knowledge, about compensation demonstrated, 2) impact of lack of compensation coverage and need for universal coverage on reserve, 3) need for community training sessions about workers’ compensation, 4) workload and financial impact of workers’ compensation on reserve, and 5) requirement for cultural competence training in the compensation board. CONCLUSIONS: This qualitative descriptive study revealed the: need for more information about applying for workers’ compensation and navigating the process, need for universal workplace insurance coverage in Indigenous communities, demand for community-based compensation process training, community costs of compensation, and the requirement for cultural safety and competence training for compensation organization employees. More education about the workers’ compensation process would be of benefit to leadership, health care providers, administrative personnel, employers, and employees on reserves. Nurses in community health centres are well situated to provide further guidance.

Surgical outcome of workman's comp patients undergoing endoscopic foraminal decompression for lumbar herniated disc

Background

Worker's compensation (WC) patients undergoing spine surgery typically experience delayed return to work (RTW) compared with non-WC patients, especially those approved for surgery undergoing traditional open spine surgery. The purpose of this study was to describe the observe RTW rates in WC patients after minimally invasive "selective endoscopic discectomy" (SED™) for a lumbar herniated disc.

Methods

Clinical outcomes using the modified Macnab criteria and RTW data were analyzed in 118 WC patients following the outpatient SED™ procedure in an ambulatory surgery center (ASC) using only local anesthesia with or without sedation. This endoscopic transforaminal decompression was trademarked by Anthony Yeung as SED.

Results

Single-level SED™ was performed in 62 patients, a two-level in 48 patients, a three-level decompression in 6, and a four-level decompression in another two patients, respectively. Patient selection was augmented by diagnostic and therapeutic injections performed preoperatively to determine how many levels of spine segments required surgical intervention. At the two-year follow-up, Excellent Macnab outcome in 36 patients, Good in 53, Fair in another 21, and Poor in the remaining eight patients, respectively. Of the 118 WC patients, 89 (75.42%) were released back to their original job within in 6 weeks from the index operation. The average time to work release was 4.2 months. Twenty-one patients who had previous spine surgery were working. Twenty-nine of the 118 study patients (24.58%) were unable to return to their original job.

Conclusions

In the hands of a well-trained endoscopic spine surgeon, RTW rates with SED™ are higher than with traditional open translaminar surgery. Therefore, endoscopic surgery should be considered for WC patients and further be validated as a cost-effective alternative to open spine surgery.