Klekamp J, McCarty E, Spengler D M
Emory Spine Center, Decatur, Georgia 30033, USA.
J Spinal Disord. 1998 Aug;11(4):277-82.
We compared the outcomes from lumbar discectomy for patients who were workers' compensation claimants and/or who were involved in active litigation with patients who underwent elective lumbar discectomy, but who were not involved with either compensation or litigation. Eighty-two consecutive patients who underwent elective lumbar discectomy by the senior author were identified from 1989 through 1994. Those patients who underwent a primary discectomy with a minimum of 6 months' follow-up were studied. Patients were excluded if a spinal fusion was performed or if a multilevel laminectomy procedure was required. Patients were classified as compensation patients if they were involved in either worker's compensation claims or active litigation at the time of the lumbar discectomy. The compensation group was further divided into three subsets of patients: those involved in active litigation without compensation, those involved in both compensation and litigation, and those pursuing workers' compensation claims without litigation. The control group was comprised of patients who were not in any way involved with compensation or litigation. Outcome assessment and ratings were determined independently by the coauthors, not the primary surgeon. Outcome was based on pain, employment status, analgesic use, and level of activity. Fifty-four patients met the inclusion criteria. Average follow-up for the compensation patients was 40 weeks. Follow-up for the noncompensation patients averaged 51 weeks. Eighty-one percent of our patients in the noncompensation group achieved a good result. Only 1 of 27 patients was categorized as having a poor outcome. Conversely, patients who were actively involved in the compensation and/or litigation process had significantly poorer outcomes, with only 29% of the patients receiving a good outcome evaluation (p = < 0.0002). Legal involvement was associated with poorer outcome in compensation patients (p = < 0.001).
我们比较了工人赔偿申请人和/或参与现行诉讼的患者接受腰椎间盘切除术后的结果，与接受择期腰椎间盘切除术但未涉及赔偿或诉讼的患者的结果。从1989年到1994年，确定了82例由资深作者进行择期腰椎间盘切除术的连续患者。对那些接受初次椎间盘切除术且至少随访6个月的患者进行了研究。如果进行了脊柱融合术或需要进行多节段椎板切除术，则将患者排除。如果患者在进行腰椎间盘切除术时涉及工人赔偿申请或现行诉讼，则将其分类为赔偿患者。赔偿组进一步分为三个患者子集：参与现行诉讼但无赔偿的患者、参与赔偿和诉讼的患者以及提出工人赔偿申请但无诉讼的患者。对照组由与赔偿或诉讼毫无关系的患者组成。结果评估和评级由共同作者独立确定，而非主刀医生。结果基于疼痛、就业状况、止痛药物使用和活动水平。54例患者符合纳入标准。赔偿患者的平均随访时间为40周。非赔偿患者的平均随访时间为51周。我们非赔偿组中81%的患者取得了良好的结果。27例患者中只有1例被归类为结果不佳。相反，积极参与赔偿和/或诉讼过程的患者结果明显较差，只有29%的患者获得了良好的结果评估（p = < 0.0002）。法律介入与赔偿患者较差的结果相关（p = < 0.001）。
