Abstract
Chronic low back pain is a common health problem for adult workers and causes an enormous economic burden. With the improvement of minimally invasive surgical techniques (MIS) in spinal fusion and the development of fusion devices, more lumbar operations are today being performed through a less invasive technique. When compared with open surgeries (OS), MIS has demonstrated better clinical outcomes including operation time, blood loss, complication rates and length of hospital stay. The aim of this review was to identify and summarize evidence on the time to return to work and the duration of post-operation narcotic use for patients who had lumbar spinal fusion operations using MIS and OS techniques. A systematic literature review was performed including studies identified from PubMed, EMBASE, the Cochrane Collaboration, and the Centre for Review and Dissemination (CRD) (January 2004–April 2014) for publications reporting on time to return to work and post-operation narcotic use after MIS or OS lumbar spinal fusion surgeries. Out of a total of 36 included studies, 28 reported on the time to return to work and 17 on the narcotic use after MIS or OS. Four studies described the time to return to work directly comparing MIS and OS. Three studies, from the US, directly compared the duration of narcotic use between MIS- transforaminal lumbar interbody fusion (TLIF) and OS-TLIF. In addition to the time to return to work, 23 studies reported on the rate of return to work and the employment rate before and after surgery, and two Swedish studies presented sick leave data. There is a gap of good quality data describing the time to return to work and narcotic use after lumbar spinal fusion operations using MIS or OS techniques. However, the current systematic literature review indicates that patients who have lumbar spinal fusion operations, with the MIS procedure, generally return to work after surgery more quickly and require less post-operation narcotics for pain control compared to patients who have OS.
Highlights
Chronic low back pain is a common health problem for adult workers and causes an enormous economic burden
This systematic literature review (SLR) was conducted to identify and summarize evidence on the time to return to work and the duration of post-operation narcotic use for patients who had lumbar spinal fusion operations using the minimally invasive surgical techniques (MIS) and open surgeries (OS) techniques
The mean follow-up period was 8 months shorter for patients in the OS group compared to the MIS group (32.9 vs. 41.1 months). In this Korean study [23] the surgical techniques were different from the three US studies [18, 21, 22] and a stringent definition of return to work was applied: “return to full and unrestricted activity”, as a result, the time to return to work for both the MIS and the OS groups were different from the results presented in the US studies [18, 21, 22], potentially reflecting cultural practices in Korea
Summary
Chronic low back pain is a common health problem for adult workers and causes an enormous economic burden. Chronic low back pain is a leading common health problem for adult workers worldwide [1, 2]; it is the leading cause of activity limitation, job-related disability and absence from work, and it causes an enormous economic burden [3]. Surgical treatment of the lumbar spine has been shown to be effective in reducing patient’s pain and improving function and disability relative to non-surgical treatment [6]. Lumbar spinal fusion surgery is a viable treatment option for reducing pain and improving function in patients with chronic pain refractory to non-surgical care [9]
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