I’m out of work on Workers’ Comp for a back injury. I have two choices: rehab for six weeks or surgery and then rehab. I’m very eager to get back to a project I’ve been working on for two years. I really don’t have the luxury of six weeks off. My dilemma is if rehab doesn’t work, then surgery is the next step. Should I save time and just cut to the surgery step?

Many workers face this challenge. Should I wait for natural healing to take place? Should I play the surgery card and hope for the best? Financial incentives, work projects, and personal expectations crowd in to make the decision even more difficult.

Surgeons can’t always predict who will have a good result from surgery. Since even the most minimally invasive procedure is still invasive compared to conservative (nonoperative) care, most surgeons would advise rehab first, surgery later — and surgery only if rehab fails. That recommendation is based on many studies showing the long-term outcomes of treatment.

And there have been special studies just comparing results of treatment for Workers’ Compensation versus nonWorkers’ Compensation patients. The studies consistently show that Workers’ Comp patients don’t do as well as nonWorkers’ Comp patients. The reasons for this aren’t entirely clear yet. All indications are that the association between Workers’ Compensation status and results is a complex one.

For a decision like this, it may be best to discuss with your surgeon the risks and benefits for you of rehab versus surgery. Your choice should be based on an informed decision-making process. Using surgery as a way to get back to work faster isn’t guaranteed. Your surgeon will review all of the information about your back problem and give you a range from best case scenario to worst case scenario.