Poorer Preoperative Function Leads to Delayed Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy

Graham S Goh; Ming Han Lincoln Liow; Zhixing Marcus Ling; Chang-Ming Guo; Wai-Mun Yue; Seang-Beng Tan; John Li-Tat Chen; Reuben Chee Cheong Soh

doi:10.14444/8150

Poorer Preoperative Function Leads to Delayed Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy

Int J Spine Surg. 2021 Dec;15(6):1184-1191. doi: 10.14444/8150.

Authors

Graham S Goh¹, Ming Han Lincoln Liow², Zhixing Marcus Ling², Chang-Ming Guo², Wai-Mun Yue³, Seang-Beng Tan⁴, John Li-Tat Chen², Reuben Chee Cheong Soh²

Affiliations

¹ Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore goh.graham@gmail.com.
² Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
³ The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore, Singapore.
⁴ Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore.

PMID: 35086876
PMCID: PMC9469042
DOI: 10.14444/8150

Abstract

Background: The factors that affect return to work (RTW) after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) remain unclear, especially in a non-Workers' Compensation setting. We aimed to (1) identify factors that influence RTW in patients undergoing ACDF (2) determine if early RTW plays a role in functional outcomes, quality of life, and satisfaction.

Methods: Prospectively collected data of 103 working adults who underwent primary ACDF for DCM were retrospectively reviewed. Patients were stratified into 2 groups: early RTW (≤60 days, n = 42) and late RTW (>60 days, n = 61).

Results: The mean time taken to RTW was 34.7 and 134.9 days in the early and late RTW groups, respectively (P < 0.001). The early RTW group had significantly better preoperative Japan Orthopaedic Association (JOA) score and Neck Disability Index (NDI) (P < 0.05) and showed a trend toward higher 36-Item Short Form Physical Component Summary (PCS) (P = 0.071). The early RTW group also had significantly better postoperative JOA, NDI, and PCS at 6 months and less arm pain along with a trend toward better NDI at 2 years (P = 0.055). However, there was no difference in the change in outcome scores and a similar proportion in each group attained the minimal clinically important difference for each metric. At 2 years, 85.7% and 77.0% were satisfied in the early and late RTW groups, respectively (P = 0.275).

Conclusions: While working adults that RTW later tend to have poorer function preoperatively and up to 2 years postoperatively, surgeons may reassure them that they will likely experience the same degree of clinical improvement and level of satisfaction after ACDF.

Level of evidence: Level 3, therapeutic study.

Keywords: anterior cervical discectomy and fusion; cervical fusion; cervical spine; myelopathy; outcomes; return to work; satisfaction.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.