Pre- and postoperative factors associated with return to work following surgery for lumbar spinal stenosis

Abstract

Low back disorders are an increasingly common and costly health problem in Western countries. It has been recommended that the return to work of patients should be the most important outcome measure of medical care. The aim of this study was to compare women's and men's working capacity after lumbar spinal stenosis (LSS) operations and to identify the factors related to it. The subjects of this study were 185 women (mean age 54 years, mean follow‐up time 4.2 years) and 254 men (mean age 52 years, mean follow‐up time 4.3 years). After the operation, 37% of the women and 41% of the men returned to work. None of the patients who had retired before the operation returned to work afterward. The variables that predicted postoperative ability to work for women were: being fit to work at the time of operation, age <50 years at the time of operation, and duration of LSS symptoms <2 years. For men, these variables were: being fit to work at the time of operation, age <50 years at the time of operation, no prior surgery, and the extent of the surgical procedure equal to or less than 1 laminectomy. Women's and men's working capacity do not differ after LSS operation. If the aim is to maximize working capacity, then, when an LSS operation is indicated, it should be performed without delay. In LSS patients who are >50 years old and on sick leave, it is unrealistic to expect that they will return to work. Therefore, after such an extensive surgical procedure, re‐education of patients for lighter job could improve the chances of these patients returning to work. © 1996 Wiley‐Liss, Inc.

Predictors for work incapacity continuing after disc surgery

“…Patients with long-lasting preoperative work disability were found more often in the poor outcome group. This finding is in agreement with the results of several authors (5,9,43). In agreement with the conclusions of Hasenbring et a1 (18), the number of daily hassles was negatively related to the resumption of work after disc herniation surgery.…”

“…Attempts to make outcome studies of disc herniation have been confounded by the paradox that the most relevant problem (pain) is not objective, whereas the most objective signs are often not relevant to the patient's function and sense of well-being. Return to work is a more useful and objective outcome measurement (4,5). Moreover, the Task Force on Pain in the Workplace of the International Association for the Study of Pain has stated that work loss is the most important consequence of low-back pain and that return to work is the most important outcome measure of medical care (6).…”

Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

“…A clinically significant change (effect size) was considered to be 12 points. Postoperative standard deviation (SD) was estimated to be 18 based on the earlier works [15][16][17]. Thus, 37 patients per group would be sufficient to detect a 12 point clinically significant difference in ODI.…”

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

“…A practical screening tool to identify patients at risk of long-term sick leave may further enhance cost-effectiveness [35]. In case of severe relapsing low back pain despite conservative treatment and when surgery is perceived as an invaluable option, intervention needs to be performed without undue delay [36][37][38].…”