The aim of this study was to assess the outcome of various modes of treatment for low back disorders in terms of eventual physical impairment and disability.

Between 1998 and 2001 the author assessed for compensation purposes 135 adult men and women with low back disorders, following the bio-psychosocial approach described by Waddell. Grades of impairment and disability were compared in respect of various treatment categories, including non-surgical treatment, discectomy (single procedure), fusion (single procedure), single surgical procedure (any type), multiple surgical procedures (any type). The last category comprised patients with recognisable psychosocial features, regardless of treatment.

Mean results for the different categories show considerable variation between patients. Although the results are not mathematically pure, there are certain clear trends. Non-surgical treatment gives the lowest impairment on the Wad-dell scale. A single surgical procedure, regardless of type, results in 56% greater physical impairment than non-surgical treatment. With multiple surgical procedures, impairment increases in proportion to the number of procedures. Patients with recognisable psychosocial features show proportionately more inappropriate symptoms and signs, regardless of treatment. Patients’ subjective sense of disability and distress is usually higher than their objectively assessed physical impairment.