Workers compensation patients undergoing lumbar spine surgery don’t do as well post-surgery as other patients undergoing the same procedures, according to two recently published studies in the peer-reviewed Journal of Neurosurgery: Spine.

The most recent article, “Effect of workers’ compensation status on pain, disability, quality of life, and return to work after anterior cervical discectomy and fusion: a 1-year propensity score–matched analysis,” published on July 21, 2023, analyzed 9957 patients who had had 1 – 4-level anterior cervical discectomy and fusion (ACDF).

One-year postoperative improvements, return-to-work rates and satisfaction were all much lower lower for workers’ compensation compared with non-workers compensation patients, even though the workers’ compensation patients had fewer comorbidities and were younger.

A previous article, “Effect of workers’ compensation status on pain, disability, quality of life, and return to work after lumbar spine surgery: a 1-year propensity-matched analysis,” published on March 24, 2023, evaluated 29,500 cases. It also found that worker’s compensation patients were significantly more likely to experience greater pain and residual disability, as well as a delayed return to work, than other patients.

The largest study of its kind to date, the research focused on data compiled on patients who underwent 1- to 4-level lumbar spinal fusion or decompression alone, as reported to the Quality Outcomes Database (QOD). The data included one-year patient-reported outcomes from more than 200 hospital systems from 2012 to 2021. All patients complained of back pain prior to surgery. The workers’ compensation patients were younger, more overweight and less likely to have a college or postgraduate education than the non-workers’ compensation population; they were also twice as likely to be smokers.

While the study theorized that the reasons for worse outcomes in the workers’ compensation patients could be due to a variety of reasons, including injury severity, socioeconomic factors, and biopsychosocial behavior such as exacerbated illness promoting disability payments.

The study concluded that identifying the causes for the negative effects on these patients could yield better outcomes.

“These studies confirm that workers’ compensation patients are significantly more likely to experience greater pain and residual disability, as well as delayed return to work, than other patients who have the same procedures,” noted Gerry Stanley, M.D., Chief Medical Officer at Harvard MedTech, an author on both studies. “Consequently, these patients experienced a lower quality of life, higher cost for treatment, and a greater likelihood of reliance on addictive pain medications.”