Work Status as a Predictor of Surgical Outcome of Discogenic Low Back Pain

Abstract

Prospective observational study. To evaluate the role of work status as a predictor of outcome from anterior lumbar fusion. Many psychosocial factors have been identified as predictors of chronic disability and of outcomes of surgery. Workers' Compensation and job satisfaction are two of the strongest and most evaluated factors. Work status at the time of intervention may also be relevant but has rarely been studied independently in patients having lumbar fusion. A total of 106 patients with discogenic low back pain were treated by anterior lumbar interbody fusion. Patients were prospectively monitored by VAS, Roland Morris score, and work status. The influence of preoperative work status on outcome variables was assessed using odds ratios. A multivariate analysis was performed to assess influence of other confounding variables. Follow-up was a mean 29.7 months with 95% greater than 1 year. Patients working at the time of surgery had a 10.5 times greater likelihood of working at follow-up. Overall, only 43% of nonworkers were working at follow-up compared with 90% of patients who were working before surgery. This association was independent of Workers' Compensation, number of levels treated, and other demographic variables. A greater degree of pain relief was seen in patients working before surgery but not in function as measured by the Roland Morris score. These results show that patients with chronic low back pain should be encouraged to continue working up until surgery.