Newswise — 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 PatientsThe 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.

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 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.

About SpineRecognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among subspecialty orthopedic titles. Visit the journal website at www.spinejournal.com

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is 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. Major brands include traditional publishers of medical and drug reference tools and textbooks, such as Lippincott Williams & Wilkins and Facts & Comparisons®; and electronic information providers, such as Ovid®, UpToDate®, Medi-Span® and ProVation® Medical.

Wolters Kluwer Health is part of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Visit www.wolterskluwer.com for information about our market positions, customers, brands, and organization.

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