Long-term work capability after spine surgery: Decompression vs. Fusion

2011

SUMMARY

A review of 146 consecutive patients age 19 – 60 years who were working before their spine surgery showed that long-term employability depends on the procedure performed. At 55 months follow-up, both decompression (89%) and fusion patients (93%) improved ODI and VAS outcomes and were still working: Discectomy-92%, Laminectomy 1-2 levels-80%, Fusion 1-2 levels- 95%, Fusion > 2 levels- 89% were still working full-time at final follow-up. When counseling patients on spinal surgery, return to work is likely.

INTRODUCTION

The ability to return to work after spine surgery, remain working long-term, and nature of that work have not been well studied in the non-work comp population. Patients undergoing decompression typically return to work earlier than after fusion, but their long-term success in the work force is unknown. We analyzed patients' ability to work long-term at average 4.5 years after primary spinal surgery.

METHODS

A review of prospective data on 146 consecutive patients from a surgical database who were working before surgery: Diskectomy-25, Laminectomy 1-2 level- 15, Laminectomy>2 levels- 6, Fusion 1-2 levels- 64, Fusion>2 levels- 36. Age averaged 45 years (19-60 years). Excluded: workers comp, revision surgery, unemployed, retired, or students. Work type defined: sedentary, medium, or heavy.

RESULTS

At 55 months follow-up (range 24 – 106 months), complications: nonunion-1, adjacent degeneration-24, painful hardware-2, infection-2, neuro-0. Decompression patients returned to pre-op levels of work sooner than fusion patients (7 vs. 19 weeks, p=0.008). Long-term work was similar; decompression- 41/46 (89%), fusion- 93/100 (93%). Working long-term by surgery: Primary diskectomy-23/25, Laminectomy 1-2 levels-12/15, Laminectomy>2 levels-6/6, Fusion 1-2 levels-61/64, Fusion>2 levels- 32/36. Significant improvements were seen in VAS (pre-6.0, post-2.9, P<0.001) and ODI (pre-44.7, post-25.2, P<0.001) for both decompression and fusion patients.

CONCLUSIONS

At 55 months follow-up, both decompression (89%) and fusion patients (93%) improved ODI and VAS outcomes, had returned to work and were still working. Returning to work after fusion takes an average of 3 months longer than returning after decompression.

SIGNIFICANCE

The expectation of long-term employability after primary spinal surgery depends on the procedure performed: Diskectomy-92%, Laminectomy 1-2 levels-80%, Fusion 1-2 levels- 95%, Fusion > 2 levels- 89%. When counseling patients on spinal surgery, return to work is likely.