J Korean Neurosurg Soc.  2020 Nov;63(6):806-813. 10.3340/jkns.2020.0227.

A Prospective Observational Study of Return to Work after Single Level Lumbar Discectomy

• Kang SH
• Yang JS
• Cho SS
• Cho YJ
• Jeon JP
• Choi HJ

• KMID: 2508611
• DOI: http://doi.org/10.3340/jkns.2020.0227

Abstract

Objective
: Lumbar disc herniation (LDH) is a common disease, and lumbar discectomy (LD) is a common neurosurgical procedure. However, there is little previous data on return to work (RTW) after LD. This study investigated the period until the RTW after LD prospectively. Clinically, the pain state at the time of RTW also checked. RTW failure rate 6 months after surgery also investigated.
Methods
: Patients with daily/regular jobs undergoing LD between September 2014 and December 2018 were enrolled. Pain was assessed by the Oswestri Disability Index (ODI) and the Numeric Rate Scale (NRS). Employment type was divided into self-employed, regular and contracted. Monthly telephone interviews were conducted to check RTW status and self-estimated work capability after surgery.
Results
: Sixty-seven patients enrolled in this study. Three patients failed to RTW, and three others resigned within 6 months after surgery. The preoperative NRS and ODI were 7.2±1.2 and 22.1±7.9, respectively. The average time to RTW was 5.1±6.0 weeks. At RTW, NRS was 1.5±1.8 and ODI was 6.3±3.9. Amongst patients that successfully returned to work were 16 self-employed workers, 42 regular employees, and three contracted workers. The time to RTW of self-employed, regular, and contracted workers were 5.9±8.8, 4.2±4.3 and 13.3±2.3 weeks, respectively (p=0.011). Thirty-six of the patients that returned to work self-reported a 22.8±15.6% reduction in work capability at 6 months.
Conclusion
: RTW may vary depending on the employment status. In this study, we found that while employment type may affect the length to RTW, most patients were able to RTW and >40% of patients reported no loss of work capabilities 6 months postoperatively, hopefully alleviating some patient hesitation towards LD.

Keyword

Lumbar; Diskectomy; Return to work; Loss of work capability; Patient reported outcome measures

Figure

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  Fig. 1. Flow chart and enrolled patients in this prospective observational cohort study. LDH : lumbar disc herniation, Pts : patients, FU : follow-up.

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  Fig. 2. Schematic of clinical result and time to return to work after single-segment lumbar discectomy. OPD : outpatients department, FU : follow-up, POD : post operation days, PreOp : pre-operation, ODI : Oswestri Disability Index, NRS : Numeric Rate Scale, RTW : return to work.

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  Fig. 3. Chronologic ratio changes of “No loss of workforce” after single-segment lumbar discectomy. Among 61 patients 41% of patients selfreported no loss of workforce at 6 months after surgery. This percentage is more improved into 47.5% and 55.7% at 12 and 18 months, respectively.

Reference

References

1. Baltzer AW, Schulitz KP. Effect of social status on occupational reintegration after lumbar discotomy. Z Orthop Ihre Grenzgeb. 135:381–385. 1997.

2. Beack JY, Chun HJ, Bak KH, Choi KS, Bae IS, Kim KD. Risk factors of secondary lumbar discectomy of a herniated lumbar disc after lumbar discectomy. J Korean Neurosurg Soc. 62:586–593. 2019.

3. Bosković K, Cigić T, Grajić M, Todorović-Tomasević S, Knezević A. The quality of life of patients after a lumbar microdiscectomy: a four-year monitoring study. Clin Neurol Neurosurg. 112:557–562. 2010.

4. Celik H, Derincek A, Arslanoglu A. Interlaminar discectomy in lumbar disc herniation: shorten postoperative return to work period in recruits undergoing military training. Mil Med. 173:924–926. 2008.

5. Dohrmann GJ, Mansour N. Long-term results of various operations for lumbar disc herniation: analysis of over 39,000 patients. Med Princ Pract. 24:285–290. 2015.

6. Donceel P, Du Bois M, Lahaye D. Return to work after surgery for lumbar disc herniation. A rehabilitation-oriented approach in insurance medicine. Spine (Phila Pa 1976). 24:872–876. 1999.

7. Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, et al. Modified pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 32:E708–E712. 2007.

8. Jordan J, Konstantinou K, O'Dowd J. Herniated lumbar disc. BMJ Clin Evid. 2011:1118. 2011.

9. Jung JM, Lee SU, Hyun SJ, Kim KJ, Jahng TA, Oh CW, et al. Trends in incidence and treatment of herniated lumbar disc in Republic of Korea : a nationwide database study. J Korean Neurosurg Soc. 63:108–118. 2020.

10. Kang SH, Choi SH, Seong NJ, Ko JM, Cho ES, Ko KP. Comparative study of lumbar magnetic resonance imaging and myelography in young soldiers with herniated lumbar disc. J Korean Neurosurg Soc. 48:501–505. 2010.

11. Kang SH, Yang JS, Cho YJ, Park SW, Ko KP. Military rank and the symptoms of lumbar disc herniation in young Korean soldiers. World Neurosurg. 82:e9–e14. 2014.

12. Koebbe CJ, Maroon JC, Abla A, El-Kadi H, Bost J. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus. 13:E3. 2002.

13. Puolakka K, Ylinen J, Neva MH, Kautiainen H, Häkkinen A. Risk factors for back pain-related loss of working time after surgery for lumbar disc herniation: a 5-year follow-up study. Eur Spine J. 17:386–392. 2008.

14. Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 9:CD010328. 2014.

15. Schade V, Semmer N, Main CJ, Hora J, Boos N. The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain. 80:239–249. 1999.

16. Schoenfeld AJ, Weiner BK. Treatment of lumbar disc herniation: evidence-based practice. Int J Gen Med. 3:209–214. 2010.

17. Shriver MF, Xie JJ, Tye EY, Rosenbaum BP, Kshettry VR, Benzel EC, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus. 39:E6. 2015.

18. Silverplats K, Lind B, Zoëga B, Halldin K, Rutberg L, Gellerstedt M, et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J. 19:1459–1467. 2010.

19. Ziegler DS, Jensen RK, Thomsen GF, Carreon L, Andersen MO. Returning to work within two years after first-time, single-level, simple lumbar discectomy: a multifactorial, predictive model. J Occup Rehabil. 30:274–287. 2020.