“Don’t talk me out of surgery, my MRI is bad and I have to get back to work.”

Some people will need surgery, but many do not. Many times a spouse will bring in their husband/wife for a second opinion on the realities of non-surgical treatment of their cervical neck problems. The spouse that has the pain issues has probably reached their “wit’s end,” they do not want to live with this problem anymore and just want to get the surgery. The surgery, they hope will be the ultimate answer and they can go back to work. For many, surgery is the answer. But for some surgery may not get them back to work. How many? The numbers below come from recent studies from medical universities and research hospitals.

Physical therapy was associated with shorter hospitalizations and increased return-to-work rates after 1 and 2 years

A combined research team from New York University NYU Hospital for Joint Diseases, the Rothman Institute, Thomas Jefferson University, Duke University, the University of Kansas Hospital, and the NY Spine Institute issued these findings on the factors impacting cervical radiculopathy patients after surgery. (1)  Included was when these people went back to work after the surgery.

• Among 1319 cervical radiculopathy patients,
  • 25.7% received preoperative epidural injections,
  • 35.3% received physical therapy, and
  • 35.5% received opioids.
• Radiculopathy patients receiving epidurals returned to work after 1 year more frequently.
• Physical therapy was associated with shorter hospitalizations and increased return-to-work rates after 1 and 2 years.

“These findings suggest certain preoperative conservative treatment modalities are associated with improved outcomes in radiculopathy patients.”

Please note: The time factors for return to work are being measured in years.

The factors for early return to work were less disability pre-surgery and better post-surgery pain and function scores.

A December 2021 study in the International Journal of Spine Surgery (2) looked for factors that affect the return to work after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy. In this study, 103 working adults who underwent primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy the researchers examined data from the group split into the early return to work groups (less than 60 days back to work) of which there were 42 patients, and, late return to work, (more than 60 days back to work) of which there were 61 patients.

The factors for early return to work were less disability pre-surgery and better post-surgery pain and function scores. At two years the early return to work and later return to work patients had overall good success with the surgery with 85.7% of the early return to workers saying they were satisfied and 77.0% of the later return to workers being satisfied.

A November 2018 paper in the journal Neurosurgical Focus (3)  tried to offer a way to better predict which patients would return to work at 3 months after cervical spine surgery.

In this paper, the authors found that among previously employed and working patients, 89.3% returned to work compared to 52.3% among those who were employed but not working (e.g., were on leave) at the time of surgery. They found that patients who were less likely to return to work were older than 56 – 65 years old, were employed but not working; were employed part-time; had a heavy-intensity or medium-intensity occupation compared to a sedentary occupation type; had workers’ compensation; had a higher Neck Disability Index score at baseline.

Approximately half of the patients returned to work within four months, and by the end of the first year, 66.9% had returned to work.

In a February 2023 study published in the medical journal Spine (4), researchers investigated what would predict a patient returning to work following cervical radiculopathy surgery. Approximately half of the patients returned to work within four months, and by the end of the first year, 66.9% had returned to work. After that, the recovery was slow, yet the proportion of the patients fully at work three years after surgery was almost equivalent to one year before surgery. The researchers found the number of sick days (90 or less) during the last year before surgery to be the strongest predictor of returning to work two years later. Those not working before the surgery were less likely to return to work after surgery.

The researchers also discovered a paradox, “although we observed a substantial improvement in disability and pain after surgery in all (patient groups), the rate of return to work was disproportionally lower than expected from the clinical improvement. Female gender, lower education, being unemployed, and receiving long-term medical benefits had considerably negative associations with the rate of return.

By 36 months, 75% had returned to work

A March 2023 study from the Department of Neurosurgery, St. Olav’s University Hospital, and the Norwegian University of Science and Technology (5) looked at the return to work rate after surgery for degenerative cervical myelopathy and found that a large percentage of patients return to work. Among 439 patients who operated for degenerative cervical myelopathy between 2012 and 2018, by 12 months after surgery, 65% had returned to work. By 36 months, 75% had returned to work. This study demonstrates that a large percentage of patients return to work after surgical treatment for degenerative cervical myelopathy.

Risk factors for failing to return to work

An August 2022 paper in the journal Cureus (6) determined the rate of return to work and contributing factors after a one- and two-level anterior cervical discectomy and fusion (ACDF).

• In this study, 68 patients were examined at three, six, and nine months after anterior cervical discectomy and fusion and the rate of return to work and contributing factors.
• The results of this study demonstrated that
  • 77.9% had returned to work after three months,
  • 82.4% had returned to work after six months and
  • the same 82.4% of workers had returned to work after nine months.
• At nine months, 82.4% of the patients had returned to work, 19.6% returned to part-time work, and 80.4% had returned to their previous work. Conversely, 17.6% of the patients had not returned to work after nine months. These patients who did not return to work were seen to be older, had longer absences from work before surgery, and had less employer support.

A February 2023 study in the Journal of Neurosurgery Spine (7) investigated factors associated with failure to return to work in cervical myelopathy patients who underwent cervical spine surgery and who were considered to have a good surgical outcome yet failed to return to work.

A total of 409 patients who underwent surgery:

• 80% (327 patients)  returned to work at 3 months after surgery.
• At 3 months, 56.9% of patients met the criteria for a good surgical outcome, and patients with a good outcome were more likely to return to work (88.1% vs 69.2%).
• Of patients with a good outcome, 11.9% failed to return to work at 3 months.
  • Risk factors for failing to return to work despite a good outcome included preoperative short-term disability or leave status; a higher baseline Neck Disability Index score and a higher neck pain score at 3 months postoperatively.

Cervical laminoplasty patients resumed work soonest

A June 2024 paper in the journal Neurosurgery, (8) doctors suggests a quicker return to work with cervical laminoplasty. In this study, patients were divided into either anterior surgery (anterior cervical decompression/fusion [ACDF]) or posterior surgery (laminoplasty, or posterior cervical decompression/fusion [PCDF], at the surgeon’s discretion).

• Work status was recorded at 1, 3, 6, and 12 months postoperatively.
• A total of 68 (42%) of 163 patients were working preoperatively and were analyzed.
  • In total, 27 patients underwent anterior cervical decompression/fusion, 29 underwent posterior cervical decompression/fusion, and 12 underwent laminoplasty.
    • 45 (66%) of 68 patients returned to work by 12 months.
    • Most employed patients returned to work within 1 year. Cervical laminoplasty patients resumed employment earliest, while posterior cervical decompression/fusion patients returned to work latest, with greater disability at follow-up, suggesting that choice of surgical intervention may influence occupational outcomes.

A May 2022 paper in the Global Spine Journal (9) found that the majority of nonretired patients undergoing surgery for degenerative cervical myelopathy had returned to work 12 months after surgery; active preoperative employment and anterior surgical approach were associated with better return to work averages before surgery.

References

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