Returning to work following any major surgical procedure is often of critical importance to an individual. This is particularly the case for Degenerative Cervical Myelopathy (DCM), where the surgery has the potential to directly improve myelopathy-related impairments that were limiting the individual’s ability to work prior to surgery.
What influences an individual’s capacity to return to work following surgery is not currently well understood. Yet insight into this question has tangible significance to not only the individual, but also society in general. In an important recent study from Canada, Nicolas Dea and co-authors investigated the rates and factors associated with return to work after surgery for DCM [1].
How was this study conducted?
The authors performed a retrospective analysis of data from 126 non-retired individuals with DCM undergoing surgical management from the multicentre Canadian Spine Outcomes and Research Network (CSORN). Return to work was defined as active employment at one year following the date of surgery.
The authors considered several factors that may be associated with return to work following surgery, including: the individual’s age, gender, duration of symptoms, occupational status (retired vs non-retired), pre-operative patient-reported questionnaires, and surgical approach (anterior vs posterior).
What was discovered?
The authors found that the majority (58.8%) of non-retired individuals prior to surgery had returned to work one year following surgery. For individuals working prior to surgery, 75.9% returned to work, with 24.1% of those not working prior to surgery returning to work.
In keeping with this, the authors applied a robust statistical analysis and found that active pre-operative employment was associated with a higher post-operative rate of returning to work. They found that age, gender and duration of symptoms were not significantly associated with post-operative return to work.
The authors additionally reported that an anterior surgical approach was associated with a higher post-operative rate of returning to work. Importantly, they noted that individuals who opted for an anterior approach often had less severe DCM and/or single spinal level involvement, suggesting that this finding may not reflect an intrinsic benefit related to the surgical approach.
Why is this important?
The findings of this study should hopefully provide reassurance, with the majority of individuals included in the study returning to work one year after surgery. More significant than the rates are arguably the factors at play, with pre-operative work status being one of the most influential factors associated with an individual’s ability to return to work. Knowing this will help to inform pre-operative counselling for surgery.
And there is also cause for optimism for individuals not working prior to surgery, but who may wish to post-operatively, with up to one quarter of those not actively employed prior to surgery working one year later.
Importantly, it is not unreasonable to hypothesise that the severity of pre-operative functional deficits due to DCM would impact the likelihood of an individual’s ability to return to work. This study did not report that to be the case, with the implication being that hope is certainly not lost if an individual’s DCM is more severe and that surgery can be very much beneficial for these individuals.
We congratulate the authors on their study. Their cohort analysis provides an important contribution to the literature surrounding DCM, with significant clinical implications. More investigation into this field will undoubtedly help to shape the clinical care of individuals with DCM and future quality improvement efforts.
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[1] Romagna A, Wilson JR, Jacobs WB, et al. Factors Associated With Return to Work After Surgery for Degenerative Cervical Spondylotic Myelopathy: Cohort Analysis From the Canadian Spine Outcomes and Research Network. Global Spine Journal. 2022;12(4):573-578. doi:10.1177/2192568220958669