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 two 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 three months, and remained better after two years.

In contrast, for workers' compensation patients, the difference between surgical and nonsurgical treatment narrowed over time. By two 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.

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 six months and two years the results are about the same as for nonsurgical 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," Dr. Atlas and colleagues write.