Diagnosis-Specific Work Disability before and after Lumbar Spine Decompression Surgery-A Register Study from Sweden.

Thomas E Dorner,Konstantinos Pazarlis,Tea Lallukka,Mo Wang,Ellenor Mittendorfer-Rutz,Magnus Helgesson,Syed Rahman,Pia Svedberg,Jenni Ervasti,Annina Ropponen

doi:10.3390/ijerph18178937

Abstract

Low back pain (LBP) patients undergoing lumbar spine decompression surgery (LSDS) often suffer from multi-comorbidity and experience high work disability. This study aimed to identify diagnosis-specific work disability patterns in all LBP-patients before and after LSDS during 2008–2010, that were aged 19–60 years and living in Sweden (n = 10,800) and compare these patterns to LBP-patients without LSDS (n = 109,179), and to matched individuals without LBP (n = 472,191). Work disability days (long-term sickness absence (LTSA), disability pension (DP)) during the three years before to three years after the cohort’s entry date were identified by generalised estimating equations. LBP-patients undergoing LSDS had higher overall work disability during the three years following surgery (LTSA: 23.6%, DP: 6.3%) than LBP-patients without LSDS (LTSA: 19.5%, DP: 5.9%), and those without LBP (LTSA: 7.9%, DP: 1.7%). Among patients undergoing LSDS, the prevalence of work disability due to dorsopathies increased from 20 days three years before surgery to 70 days in the year after and attenuated to 30 days in the third year following surgery. Work disability for other diagnoses remained stable at a low level in this group (<10 days annually). LBP-patients undergoing LSDS have an unfavourable long-term work disability prognosis, primarily due to dorsopathies. Decompression surgery seemed to restrict further inclines in work disability in the long run.

Highlights

Low back pain (LBP) is a leading diagnosis for work disability (i.e., sickness absence (SA) and disability pension (DP)) [1,2,3,4]
Previous research revealed that LBP-patients undergoing spine surgery, such as lumbar spine decompression surgery (LSDS), have an even worse prognosis in terms of work disability compared to LBP-patients without such surgery [5]
This study utilises nationwide data from five registers which are linked based on the personal identity numbers of all residents in Sweden [15] and provided by the following three different Swedish agencies: (1) Statistics Sweden, which provided data on age, sex, educational level, family situation, living area, country of birth and emigration, extracted from the longitudinal integrated database for health insurance and labour market studies (LISA) [16]; (2) The National board of Health and Welfare which provided data on the date and type of surgery based on the Swedish version of NOMESCO codes of surgical procedures, and International Classification of Diseases version 10 (ICD-10) diagnostic codes and dates for hospitalisation and specialised outpatient care, obtained from the National Patient Register [17,18], medication purchases based on the Anatomic Therapeutic

Summary

Introduction

Low back pain (LBP) is a leading diagnosis for work disability (i.e., sickness absence (SA) and disability pension (DP)) [1,2,3,4]. Previous research revealed that LBP-patients undergoing spine surgery, such as lumbar spine decompression surgery (LSDS), have an even worse prognosis in terms of work disability compared to LBP-patients without such surgery [5]. Whether or not, patients with LBP with certain disc disorders should receive surgical intervention or undergo conservative treatment options is, an issue of ongoing debate [6,7]. Examining clinical characteristics as endpoints, especially with a short-term follow-up, has shown inconclusive results or trends towards a slightly better prognosis for patients who are treated by surgical procedures compared to those treated conservatively [8,9].

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