The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation: SPORT.
METHODS
Prospective randomized and observational cohorts.


OBJECTIVE
To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH).


BACKGROUND
Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment.


METHODS
Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months.


RESULTS
Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [-5.9; 95% CI: -16.7-4.9] and physical function [5.0; 95% CI: -4.9-15]). Surgical treatment was not associated with better work or disability outcomes in either group.


CONCLUSIONS
Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment.
Atlas
Steven J
SJ
General Medicine Division, Medical Services, MA General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Tosteson
Tor D
TD
Blood
Emily A
EA
Skinner
Jonathan S
JS
Pransky
Glenn S
GS
Weinstein
James N
JN
D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D017586:Diskectomy / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D018579:Patient Selection; D011446:Prospective Studies; D012585:Sciatica / Q000188:drug therapy / Q000191:economics / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000191:economics*
D009125:Muscle Relaxants, Central; D009294:Narcotics