A third of Illinois' expenditures for workers compensation involve back injuries.

The average case now costs insurers about $6,000, but those costs could skyrocket with increasing use of a new surgical treatment that is a godsend to some patients but is ripe for abuse, says Dr. David Fletcher, medical director of Midwest Occupational Health Associates and an occupational health specialist.

Low back pain is the focus of Work Injury '98, the sixth annual conference on prevention, treatment and management of work place injuries. The conference is scheduled 8 a.m. to 4:30 p.m. Thursday, Oct. 1, at the Shilling Center on Richland Community College's campus. It is sponsored by MOHA and the Department of Family Medicine at the University of Illinois' College of Medicine.

The most common cause of back pain is degeneration of spinal discs.

"Discs are the 'shock absorbers' of your spine," explained Darrel Schapmire , an MOHA rehabilitation therapist. "When they degenerate, the distance between vertebrae is lessened."

The spinal column can be thought of as a central conduit for the body's information system. That is, it contains the central nervous system which transmits and receives signal between the brain and it's many outposts.

"Basically, nerves tell the brain what's going on with the feet, hands or any other part of the body and transmit instructions from the brain," said Schapmire.

As vertebrae become more compacted because of disc degeneration, said Schapmire, nerves in the central column become more exposed and get "pinched."

Physicians such as Dr. Terrence Pencek of Springfield have begun treating disc degeneration with the BAK Interbody Fusion procedure.

The procedure involves surgically inserting small metal cylinders between the vertebra where discs have deteriorated, said Pencek. New bone then grows through and around the cylinders, fusing the vertebral bodies and ending pain.

A two-year study of 947 patients in 19 hospitals nationwide showed a favorable outcome in 89 percent of cases, with both back function and strength maintained or improved in 94 percent of cases.

Typical patients recover in about two-thirds the time of alternative surgery, spend 40 percent less time in the hospital and lose only a third as much blood during surgery.

Ironically, development of this "breakthrough" procedure may be the catalyst that causes worker compensation costs associated with back pain to soar, Fletcher notes.

"For some people it's great," Fletcher said, "but it is also ripe for fraud (because ) the average outlay for the procedure is about $120,000."

With that kind of money at stake, greedy physicians will be tempted to recommend the procedure in cases where other, less costly remedies would be as effective or preferred, Fletcher said.

Employers and case managers will need to be diligent in monitoring back cases as physicians increase use of the technique, he added.

Pencek will describe the procedure as the keynote speaker for this year's conference. Dr. Terrance Flanagan, an Oak Lawn chiropractic physician, will discuss chiropractic treatments for low back pain.

Dr. Cynthia Guy, an anesthesiologist and pain specialist, will talk about pain management and Bill Elliott, ergonomics coordinator for Caterpillar Inc. in Decatur, will address ergonomic tools to avoid such injuries in the workplace.

Although back injuries are popularly associated with industrial settings, Schapmire said an increasing number of office workers are claiming back injuries brought on by long hours in sitting positions.

"We have two things happening (in offices)" said Schampmire, "greater reliance on computer technology and an aging work force."

As it has the past two years, the afternoon portion of the conference will be devoted to working through a case study, using the experts at hand, including physicians, employers, a claims adjuster, attorneys for both sides and an arbitrator.

Last year's conference drew 325 attendees, representing employers, health care workers, lawyers and others involved in workplace injury cases.