Poorer Preoperative Function Leads to Delayed Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy.

Abstract

The factors that affect return to work (RTW) after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) remain unclear, especially in a non-Workers' Compensation setting. We aimed to (1) identify factors that influence RTW in patients undergoing ACDF (2) determine if early RTW plays a role in functional outcomes, quality of life, and satisfaction. Prospectively collected data of 103 working adults who underwent primary ACDF for DCM were retrospectively reviewed. Patients were stratified into 2 groups: early RTW (≤60 days, n = 42) and late RTW (>60 days, n = 61). The mean time taken to RTW was 34.7 and 134.9 days in the early and late RTW groups, respectively (P < 0.001). The early RTW group had significantly better preoperative Japan Orthopaedic Association (JOA) score and Neck Disability Index (NDI) (P < 0.05) and showed a trend toward higher 36-Item Short Form Physical Component Summary (PCS) (P = 0.071). The early RTW group also had significantly better postoperative JOA, NDI, and PCS at 6 months and less arm pain along with a trend toward better NDI at 2 years (P = 0.055). However, there was no difference in the change in outcome scores and a similar proportion in each group attained the minimal clinically important difference for each metric. At 2 years, 85.7% and 77.0% were satisfied in the early and late RTW groups, respectively (P = 0.275). While working adults that RTW later tend to have poorer function preoperatively and up to 2 years postoperatively, surgeons may reassure them that they will likely experience the same degree of clinical improvement and level of satisfaction after ACDF. Level 3, therapeutic study.