There appears to be "no added benefit" of surgery for patients on workers’ compensation, according to the study, which was led by Dr. Steven J. Atlas of Massachusetts General Hospital and published in Spine.
Researchers analyzed data on 924 patients with sciatica (low back and leg pain) related to a herniated intervertebral disk. As part of a randomized trial, patients were assigned to undergo surgery or non-surgical treatment (physical therapy, education/home exercise, and pain-relieving drugs). The results found that, while both treatments were effective, surgery provided more rapid improvement and better results up to 2 years after treatment.
In the new analysis, Atlas and colleagues looked for possible differences in response to treatment for patients who were and were not receiving workers’ compensation. About 12 percent of patients in the study were on workers' compensation.
As in the main study, both treatments resulted in improvement. For non-workers' comp patients, the results of surgery were significantly better after 3 months, and remained better after 2 years. In contrast, for workers’ compensation patients, the difference between surgical and non-surgical treatment narrowed over time. By 2 years, workers' compensation patients undergoing surgery had pain and physical function comparable to those treated without surgery.
The percentage of patients returning to work or placed on disability was similar with surgery versus non-surgical treatment, regardless of workers' compensation status.
Common Workers’ Comp Claim
Sciatica related to herniated disks is a common and disabling condition, and a major reason for workers' compensation claims. Previous studies have suggested that workers' compensation status may affect the outcomes of treatment for herniated disks.
The new results suggest that the results of surgery for herniated disks are not as good in workers' compensation patients. Although they may initially recover faster after surgery, that benefit is short-lived so that between 6 months and 2 years, the results are about the same as for non-surgical treatment.
In contrast, for non-workers' compensation patients, surgery provides lasting benefits in terms of pain reduction and improved functioning. It is not clear why the results are different for patients on workers' compensation – the difference remains even after adjustment for other patient characteristics.
The findings do not imply that workers’ compensation patients should not undergo surgery. "Rather, as recommended in recent [guidelines], physicians should discuss the risks and benefits of treatment options including surgery, and treatment decisions should be based on informed choice using a shared decision-making approach," Atlas and colleagues wrote.
The journal Spine is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health and pharmacy.