DETROIT—A study and subsequent article by a Wayne State University School of Medicine professor concerning death rates after spinal fusion surgery has been identified as one of the most significant medical articles published in 2009.

The article, "Mortality after Lumbar Fusion Surgery," by Sham Maghout Juratli, M.D., assistant professor of Family Medicine and Public Health Sciences and resident of Franklin, Mich., was originally published in the journal Spine last year. Faculty of 1000 Medicine recently selected the article for inclusion as one of the most important articles published in medicine.

Faculty of 1000 Medicine identifies and evaluates what it considers the most important articles published in medicine based on the recommendations of 2,400 peer-nominated leading researchers and clinicians. Selection and inclusion of articles provide recognition from peers of scientific merit and positive contributions to medical literature.

"I am very pleased that our article was recognized as an important 'must read' article by the Faculty of 1000 Medicine," Dr. Juratli said. "It is very important to us as occupational health specialists to evaluate the health and disability outcomes related to commonly performed procedures, and I am honored that our scientific contribution is being recognized in the professional community."

Dr. Juratli's study found that pain medications are involved in more than 20 percent of deaths that occur in the years after spinal fusion surgery for low back pain. The risk of analgesic-related death is highest among patients with degenerative disc disease -- especially men aged 45 to 54 -- according to the findings.

Of 2,378 workers' compensation patients who underwent spinal fusion surgery in Washington between 1994 and 2001, 103 died by 2004. Dr. Juratli and her team analyzed the cause of death for each. The rate of death within three years after surgery was 1.9 percent. Deaths involving pain medications were the single most common category, accounting for 21 percent of all deaths. Of 22 analgesic-related deaths, 19 were accidental overdoses and three were suicides. In all, nearly 1 percent of workers who underwent spinal fusion died of analgesic poisoning.

Although other diseases like cancer or heart disease combined cause more deaths, analgesic-related deaths were the main cause of potential life-years lost because younger patients were more likely to die of analgesic poisoning, whereas older patients were more likely to die of other causes.

Workers whose back pain was primarily caused by degenerative disc disease were at elevated risk of analgesic-related death -- nearly three times higher than those with other diagnoses. The risk of death due to pain medications was highest among men aged 45 to 54 who had degenerative disc disease, more than seven times higher than for other groups.

The risk of death in the first three months after spinal fusion surgery was 0.29 percent. This risk was highest for patients who were undergoing a second spinal fusion.

The use of spinal fusion (also called lumbar fusion) is growing rapidly, despite a lack of agreement on which patients should undergo the procedure. This is of special concern because spinal fusion carries a higher risk of complications than other less-extensive surgical procedures. Although the initial risk of death is low, few studies have looked at the mortality rate beyond the first few months after spinal fusion.

The new results raise concern about the long-term risk of death after spinal fusion, especially deaths related to pain medications. The deaths reflect the high use of opioid (narcotic) analgesics by patients with back pain, despite the lack of strong evidence for their effectiveness.

"Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent spinal fusion than any other cause," Dr. Juratli and her colleagues said. They believe initial efforts to reduce analgesic-related deaths should focus on patients with degenerative disc disease, especially men.

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