The ability to work after short fusion vs. long fusion: 5 year follow-up
Patients undergoing spinal arthrodesis return to work with differing regularity, depending on motivation, chronicity, complications, and other factors. The ability of patients with adult spinal deformity to return to work and remain working long-term after surgery has not been well studied.
Comparison of clinical and radiologic outcomes, complications, and work status from employed adults undergoing short segment fusions (SSF) vs. long segment fusions (LSF) for deformity in a non-workers comp cohort.
A retrospective review of prospectively collected data from a surgical database, and radiographic review.
100 consecutive patients (39 male, 61 female): 36 LSF and 64 SSF, with average age 46 (range 19 – 60 years) who were working before surgery. Excluded: workers compensation, students, unemployed, retired.
Visual analog scores (VAS) for pain, Oswestry disability index (ODI), work status (sedentary, moderate, heavy work), and pain medication records were followed pre-op and at follow-up. Patient pain was compared using the sign test. ODI was compared using paired t-tests, Anderson-Darling was used to verify normalcy. Return to work rates were compared using Fisher's Exact Test.
LSF diagnoses: idiopathic scoliosis-22, degenerative scoliosis-5, kyphosis (Scheuermann's, degenerative, post-traumatic)-9. Length of fusion for LSF patients averaged 9.6 levels (range 4 - 15 levels); SSF diagnoses included degenerative disc disease, stenosis with instability, recurrent disc herniation, and spondylolisthesis. SSF patients were fused 1-2 levels only (average 1.4 levels). Clinical and radiologic follow-up was obtained pre-op, and post-op at 1 year, 2 years, and latest follow-up. Work type was recorded at all intervals and defined: sedentary (<15 lbs lifting), medium (15 – 40 lbs lifting), heavy work (> 40 lbs lifting).
At average follow-up 70 months (24-106 months), 61 of 64 (95.3%) SSF and 32 of 36 (88.9%) LSF patients were working. Return to work averaged 25 weeks for LSF, 17 weeks for SSF patients. SSF group had more pre-op pain and worked more sedentary jobs (61% vs. 39%). VAS improved for LSF: 5.2pre-op to 2.5 at 2 years (P=0.004); SSF: 6.3 pre to 2.5 at 2 years (P<0.001). ODI improved for LSF: 32.4 pre-op to 22.7 at 2 years (P=0.0042); SSF improved 44.7 pre-op to 21.3 at 2 years (P<0.001). Pain med use declined for both groups. There was no difference between SSF and LSF groups in ability to return to work, sedentary/medium/heavy (P=0.247). LSF group was not more likely to return to sedentary work than SSF patients.
Workers undergoing fusion for spinal deformity can reliably return to work and remain working long-term. Long-term outcomes and work status are similar to SSF patients. Deformity patients can be assured they have an excellent chance to return to work and remain working long-term after LSF.
(2011) Primary vs. revision spine surgery: Long-term work status and outcomes
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 (4.5 years) and work type after primary and revision spinal surgery.
Retrospective review of prospectively collected data from a consecutive patient surgical database
Patient Sample 206 patients working adults who required spinal surgery; Age averaged 45 years (19-60yrs). Excluded: work compensation, unemployed, retired, students
Outcomes Measure VAS, Oswestry Disability Index (ODI), pain medication records pre-op, 1 year, 2 years, and latest follow-up
Diagnosis included degenerative disease, stenosis, spondylolisthesis, and deformity. Surgery performed: 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); Work type: sedentary, medium, heavy. Outcomes were compared pre-op, 1 year, 2 years, latest follow-up for primary and revision surgery. The time to return to work was compared using two factor ANOVA as a function of pre-surgical work level (sedentary, medium, heavy) and the type of surgery. Normalcy of data was confirmed through construction of a normal probability plot. Statistical analysis was performed using Minitab.
Patients in this series returned to work at an average of 16 weeks post-op (range 4-114 weeks); At average 55 months follow-up (24 – 106 months), the following patients had returned to the same level of work as pre-op and 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).
The average time to return to work is dependent on type of surgery performed more than primary vs. revision surgery. Moreover, patients work type does not dictate how long it will take them to return to work. Patients can be counseled that a return to work is reliable and likely following spinal surgery, whether primary or revision.