Long-term ability to work after primary vs. revision spine surgery

2011

SUMMARY

This 55 month follow-up of outcomes and long-term work status of 206 working patients (excluded: unemployed, workers comp, students, retired), age 45 (19-60) undergoing spinal surgery: Decompression-57 (primary: 46, revision-11), Fusion-149 (primary: 100, revision-49); The average time to return to work depended on surgery type, but not work type (sedentary, medium, heavy). Return to work for revision and primary surgery was similar. Patients can be counseled that a return to pre-op levels of work is not only possible, but likely, even for revision cases.

INTRODUCTION

The ability to return to work and remain working long-term after spine surgery in the non-workers comp population has not been well studied. We analyzed ability to work long-term and work type after primary and revision spinal surgery.

METHODS

This is a review of 206 consecutive working patients, age 45 years (19-60 yrs), undergoing spinal surgery: Decompression-57 (primary:Discectomy-25, Laminectomy 1-2 level-15, Laminectomy >2 levels-6; Revision lami-11), Fusion-149 (primary: Fusion 1-2 levels-64, Fusion>2 levels-36; Revision Fusion-49); Excluded: work comp, unemployed, retired, students; Work classified as: sedentary, medium, heavy. Outcomes were compared pre-op, 1 year, 2 years, latest follow-up for surgery type, work type, primary and revision surgery.

RESULTS

Return to work averaged 16 weeks (4-114 weeks); At 55 months follow-up (24–106months), the following were still working long-term: Short fusions- 61/64 (95%), Long fusions- 32/36 (88%), Revision fusion- 38/49 (78%), (p=0.004 vs. SSF). Long-term work for decompression patients: Primary Laminectomy 1-2 levels – 12/15 (80%), Laminectomy > 2 levels- 6/6 (100%), and Revision Laminectomy- 10/11 (91%). Patients undergoing primary fusions returned to work 19.7 weeks post-op (range 2- 63 weeks), similar to revision fusions returned to work at 18.6 weeks (range 2- 75 weeks). Primary decompression surgeries returned to full duty at an average of 7.6 weeks (1 – 42 weeks), similar to revision decompressions return at 8.0 weeks (1-28 weeks). ANOVA showed that number of weeks to return was a function of both surgical type (p<0.001) and work level (p=0.019). Number of weeks was approximately equal for sedentary, medium, and heavy workers. All fusions were slower to return (19.4 + 16.9 weeks) than primary laminectomies, primary discectomies, and revision decompressions (7.7+8.1 weeks).

CONCLUSIONS

The average time to return to work is relatively low independent of surgery but is dependent on type of surgery performed. Moreover, patients work type does not dictate how long it will take them to return to work.

SIGNIFICANCE

Patients can be counseled that a return to work within several months is likely following spinal surgery.