Surgery provides better results than nonsurgical treatment for most patients with back pain related to a herniated disk—but not for those receiving workers' compensation for work-related injuries, reports a study in the January 1 issue of Spine. The journal 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.
There appears to be "no added benefit" of surgery for patients on workers' compensation, according to the new study, led by Dr. Steven J. Atlas of Massachusetts General Hospital.
Better Results with Surgery, but not in Workers' Compensation Patients
The 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 called SPORT, patients were assigned to undergo surgery or nonsurgical treatment (physical therapy, education/home exercise, and pain-relieving drugs). The main SPORT 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, Dr. 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' compensation 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 nonsurgical 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 nonsurgical treatment. This was so regardless of workers' compensation status.