People with back and neck problems want to get well, get their lives back, and get back to work. Physicians and other spine care providers focus on decreasing pain in an effort to get these people back into their full speed lives again. Usually, appropriate exercise and conservative care is all that is required. Occasionally, surgery may be required to reestablish full function.
Years ago, spine surgery developed a well deserved reputation for causing as much back pain as it helped. Rarely did surgery deliver as much benefit as it hoped. Over the past twenty years of my career, advances in our ability to diagnose and treat spinal disease have expanded dramatically. With the latest techniques, we are now able to get people back to work and back to life after spine surgery very reliably.
- So what should workers expect from spine surgery?
- How long does it take to recover?
- How realistic is it that a person could return to work after spinal fusion?
- Can a person who has had multiple back surgeries ever work again?
In order to answer these and other questions related to work after surgery, we conducted a research study through the Sonoran Spine Research and Education Foundation. The purpose of our study was to define the expectations for returning to work for different kinds of spine surgery, from minimal lumbar diskectomy to major spinal reconstruction and fusion of several vertebrae. Based on our experience, our hypothesis or expected finding from this study was that the majority of patients, who were working before surgery, went back to work after surgery and were able to stay in the work force for an extended period of time.
Study of Workers - We studied 255 patients, all adults between age 19 and age 60, who were working full time prior to their lumbar surgery. Some had to stop working before surgery due to pain, but they had the capability to work and hoped to get back to work following surgery. Excluded from the study were patients who were retired, students, the unemployed, and any patients involved in a worker's compensation claim or litigation of any sort (for instance someone involved in a car accident who was suing the driver of the other car).
The average age of these 255 patients was 45.2 years old with the age ranging from 19 to age 60. We broke down the type of work performed into sedentary (122 patients) medium work (100 patients) heavy work (23 patients) and work type unknown (10 patients).
The diagnoses for this group of patients included disc herniation, recurrent disc herniation, spinal deformity such as scoliosis or kyphosis, shifting or unstable vertebra such as spondylolisthesis, arthritic conditions involving nerve compression, and patients requiring revision spine surgery for prior failed surgical attempts.
All 255 patients were asked to fill out questionnaires before surgery and at regular intervals after surgery regarding how they felt and how well they were doing. The average patient was questioned four years after their surgery. They were all asked to rank their pain on a scale of 1 to 10 as to severity, asked about their need for pain medication, and asked about their physical fitness and function.
Results from surgery... 4 years later - On average, the 255 patients in our study complained of pain of 6 or 7 out of 10 on a scale of 1 to 10 before surgery. One year following surgery, they noted the pain had improved to about 2 or 3 out of 10. For patients with the smallest surgery, lumbar disc herniation, pain after 4 years was rated 1 or 2 out of 10. For patients who had undergone the largest surgeries, long fusions, pre-op pain improved from 7/10 to 3 – 4/10 at four years. Medication use also decreased significantly after surgery, with average patient taking daily heavy pain medication to control discomfort before surgery, and 4 years later requiring much less pain pill use. Functional improvement in things like walking, sitting and performing hobbies also had improved significantly four years after surgery.
Return to work depends on the surgery? - Looking specifically at long term work for these 255 patients, 95% of those undergoing lumbar discectomy were still working four years later. For patients requiring laminectomy for spinal stenosis or nerve compression as a result of arthritis, 81% were still working four years after surgery. Interestingly, of the 124 patients undergoing a short fusion, namely a fusion of one or two levels to control an unstable segment or something similar, 90% were still working full time four years after surgery. For patients with spinal deformity who required long fusions of many levels in the spine, 80% were still working full time four years after surgery.
1. Our study showed that a strong majority of patients not only returned to work following spine surgery, but they are able to remain at work long term.
After an average 4 years, the following were still working:
- Lumbar Diskectomy - 95%
- Lumbar Laminectomy - 81%
- Short Fusion - 90%
- Long Fusion - 80%
2. Don't fear the fusion. Fusion of one to two levels were more likely to be working full time after 4 years than patients who underwent laminectomy at 2 or more levels to relieve pressure on pinched nerves. This is most likely due to the dramatic pain relief from fusing a painful back. People feel so much better that they want to get back to work and stay at work long term.
3. Even people who had major spine fusions returned to work – We were surprised at how many patients undergoing major surgery for a deformed spine who required multiple levels of fusion (long fusion group, 61 patients) were still working 4 years after surgery. An astounding eighty percent, or 4 out of 5 of these patients had not only returned to work but remained actively working long term.
4. For best results, have a successful surgery the first time - Patients undergoing their first spine surgery (primary fusion or primary lumbar diskectomy) were far more likely to remain at work long term than patients who required revision lumbar surgery. An example: 96% of patients were working long term after their first lumbar fusion and 79% of patients were working after revision of a failed fusion attempt.
5. Even patients requiring multiple surgeries are able to work long term after revision surgery.
The take home messages from this study are first, people who are working prior to needed spinal surgery are usually able to return to work and stay working long term if they want to. Even people requiring bigger surgeries like spinal fusion are 90% likely to return to work and stay at work long term. While most people recover from back pain through exercise and healthy lifestyles, those who require surgery can expect to return to work and "get their life back" too.