Secondary gain influences the outcome of lumbar but not cervical disc surgery

BACKGROUND The expectation of monetary compensation has been associated wit h poor outcomes in lumbar discectomy, fueling a reluctance among surgeons t o treat worker's compensation cases. This issue, however, has not been inve stigated in patients undergoing cervical disc surgery. This study analyzes the relationship between economic forms of secondary gain and surgical outc ome in a group of patients with common pay scales, retirement plans, and di sability programs. METHODS All procedures were performed at the Portsmouth Naval Medical Cente r between 1993 and 1995; active duty military servicepersons who were treat ed for cervical radiculopathy were prospectively included. Clinical, demogr aphic, and financial factors were analyzed to determine which were predicti ve for outcome. Financial data were used to create a compensation incentive (CI) which is proportional to the rank, years of service, potential disabi lity, retirement eligibility, and base pay and reflects the monetary incent ive of disability. The results of cervical surgery were compared to a previ ously reported companion population of patients treated for lumbar disc dis ease. A good outcome is defined as a return to active duty, whereas a refer ral for disability is considered a poor surgical result. RESULTS One hundred percent follow-up was obtained for 269 patients who wer e treated with 307 cervical operations. Only 16% (43/269) of cervical patie nts received disability, whereas 24.7% (86/348) of lumbar patients obtained a poor result (p = 0.0082). Although economic forms of secondary gain were not associated with outcome in cervical disease, both the position (p = 0. 002) and duration of an individual's military career were significant facto rs (p = 0.02). Of the medical variables tested, multilevel surgery (p = 0.0 3) and revision operations at the same level (p = 0.03) were associated wit h referral for medical discharge. CONCLUSIONS Secondary gain in the form of economic compensation influences outcome in lumbar but not cervical disc surgery; this observation may in pa rt account for the success of cervical surgery relative to lumbar discectom y. Social factors that are independent of the anticipation of economic comp ensation seem to influence the outcome of cervical disc surgery. (C) 1999 b y Elsevier Science Inc.