Comp patients get 'no added benefit' from back surgery, study finds

Employees on workers' compensation who undergo surgery for back pain don't experience better outcomes than individuals who receive nonsurgical treatment, according to a study.

The report, published in Spine journal, found that while surgery provides better results than nonsurgical treatment for most patients with back pain related to a herniated disc, there appears to be "no added benefit" of surgery for patients on workers' comp.

The research team, led by Dr. Steven J. Atlas of Massachusetts General Hospital, analyzed data on 924 patients with sciatica (low back and leg pain) related to a herniated intervertebral disc. Sciatica related to herniated discs is a common and disabling condition and is a major source of workers' comp claims. Previous studies have suggested that workers' comp status may affect the outcomes of treatment for herniated discs.

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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, Atlas and his colleagues looked for possible differences in response to treatment for patients who were and were not receiving workers' comp. About 12 percent of patients in the study were on workers' comp.

As in the main study, both treatments resulted in improvement. For non-workers' comp patients, the results of surgery were significantly better after three months and remained better after two years. In contrast, for workers' comp patients, the difference between surgical and nonsurgical treatment narrowed over time. By two years, workers' comp patients undergoing surgery had pain and physical function comparable to those treated without surgery.

Researchers said the percentage of patients returning to work or placed on disability was similar with surgery versus nonsurgical treatment, regardless of workers' comp status.

Atlas said it is not clear why the results are different for patients on workers' compensation. The study found that the difference remains even after adjustment for other patient characteristics. The findings, he said, do not imply that workers' comp 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 said.

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March 18, 2010

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