Worker compensation is intended for injuries that occur at work. Surgery under worker compensation would be expected to be mostly for trauma and largely non-discretionary conditions. But when we studied it, we found that among patients treated under worker compensation, the ratio of likely discretionary to likely nondiscretionary surgery was significantly higher for traumatic diagnoses and significantly lower for nontraumatic diagnoses compared with commercial insurance (1). Worker compensation often covers likely discretionary musculoskeletal surgery, and insurance type may influence treatment.
Another study aimed to determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with chronic back pain and previously asymptomatic low-grade isthmic spondylolisthesis. All 13 patients involved in worker compensation claims or pending litigation had fair or poor results (2). Nine of 11 patients without such issues had good or excellent results. Although the strong association of worker compensation with poor results made it difficult to assess the importance of other risk factors, the data suggests that good results may be more likely in patients with radiculopathy who undergo laminectomy.
References
- van der Gronde BATD, Crijns TJ, Ring D, Leung N. Discretionary Surgery: A Comparison of Workers’ Compensation and Commercial Insurance. Hand (N Y). 2018 Sep 7:1558944718799392. doi: 10.1177/1558944718799392. [Epub ahead of print] PubMed PMID: 30192641.
- Vaccaro AR, Ring D, Scuderi G, Cohen DS, Garfin SR. Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis. Spine. 1997;22(17):2030-4; discussion 2035.