TY - JOUR
T1 - Patients May Return to Work Sooner after Laminoplasty
T2 - Occupational Outcomes of the Cervical Spondylotic Myelopathy Surgical Trial
AU - Miranda, Stephen P.
AU - Whitmore, Robert G.
AU - Kanter, Adam
AU - Mummaneni, Praveen V.
AU - Bisson, Erica F.
AU - Barker, Fred G.
AU - Harrop, James
AU - Magge, Subu N.
AU - Heary, Robert F.
AU - Fehlings, Michael G.
AU - Albert, Todd J.
AU - Arnold, Paul M.
AU - Riew, K. Daniel
AU - Steinmetz, Michael P.
AU - Wang, Marjorie C.
AU - Heller, John G.
AU - Benzel, Edward C.
AU - Ghogawala, Zoher
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2024. Unauthorized reproduction of this article is prohibited.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - BACKGROUND AND OBJECTIVES:Return-to-work (RTW) is an important outcome for employed patients considering surgery for cervical spondylotic myelopathy (CSM). We conducted a post hoc analysis of patients as-treated in the Cervical Spondylotic Myelopathy Surgical Trial, a prospective, randomized trial comparing surgical approaches for CSM to evaluate factors associated with RTW.METHODS:In the trial, patients were randomized (2:3) to either anterior surgery (anterior cervical decompression/fusion [ACDF]) or posterior surgery (laminoplasty [LP], or posterior cervical decompression/fusion [PCDF], at surgeon's discretion). Work status was recorded at 1, 3, 6, and 12 months postoperatively. For patients working full-time or part-time on enrollment, time to RTW was compared across as-treated surgical groups using discrete-time survival analysis. Multivariate logistic regression was used to assess predictors of RTW. Clinical outcomes were compared using a linear mixed-effects model.RESULTS:A total of 68 (42%) of 163 patients were working preoperatively and were analyzed. In total, 27 patients underwent ACDF, 29 underwent PCDF, and 12 underwent LP. 45 (66%) of 68 patients returned to work by 12 months. Median time to RTW differed by surgical approach (LP = 1 month, ACDF = 3 months, PCDF = 6 months; P =.02). Patients with longer length-of-stay were less likely to be working at 1 month (odds ratio 0.51; 95% CI, 0.29-0.91; P =.022) and 3 months (odds ratio 0.39; 95% CI, 0.16-0.96; P =.04). At 3 months, PCDF was associated with lower Short-Form 36 physical component summary scores than ACDF (estimated mean difference [EMD]: 6.42; 95% CI, 1.4-11.4; P =.007) and LP (EMD: 7.98; 95% CI, 2.7-13.3; P =.003), and higher Neck Disability Index scores than ACDF (EMD: 12.48; 95% CI, 2.3-22.7; P =.01) and LP (EMD: 15.22; 95% CI, 2.3-28.1; P =.014), indicating worse perceived physical functioning and greater disability, respectively.CONCLUSION:Most employed patients returned to work within 1 year. LP patients resumed employment earliest, while PCDF patients returned to work latest, with greater disability at follow-up, suggesting that choice of surgical intervention may influence occupational outcomes.
AB - BACKGROUND AND OBJECTIVES:Return-to-work (RTW) is an important outcome for employed patients considering surgery for cervical spondylotic myelopathy (CSM). We conducted a post hoc analysis of patients as-treated in the Cervical Spondylotic Myelopathy Surgical Trial, a prospective, randomized trial comparing surgical approaches for CSM to evaluate factors associated with RTW.METHODS:In the trial, patients were randomized (2:3) to either anterior surgery (anterior cervical decompression/fusion [ACDF]) or posterior surgery (laminoplasty [LP], or posterior cervical decompression/fusion [PCDF], at surgeon's discretion). Work status was recorded at 1, 3, 6, and 12 months postoperatively. For patients working full-time or part-time on enrollment, time to RTW was compared across as-treated surgical groups using discrete-time survival analysis. Multivariate logistic regression was used to assess predictors of RTW. Clinical outcomes were compared using a linear mixed-effects model.RESULTS:A total of 68 (42%) of 163 patients were working preoperatively and were analyzed. In total, 27 patients underwent ACDF, 29 underwent PCDF, and 12 underwent LP. 45 (66%) of 68 patients returned to work by 12 months. Median time to RTW differed by surgical approach (LP = 1 month, ACDF = 3 months, PCDF = 6 months; P =.02). Patients with longer length-of-stay were less likely to be working at 1 month (odds ratio 0.51; 95% CI, 0.29-0.91; P =.022) and 3 months (odds ratio 0.39; 95% CI, 0.16-0.96; P =.04). At 3 months, PCDF was associated with lower Short-Form 36 physical component summary scores than ACDF (estimated mean difference [EMD]: 6.42; 95% CI, 1.4-11.4; P =.007) and LP (EMD: 7.98; 95% CI, 2.7-13.3; P =.003), and higher Neck Disability Index scores than ACDF (EMD: 12.48; 95% CI, 2.3-22.7; P =.01) and LP (EMD: 15.22; 95% CI, 2.3-28.1; P =.014), indicating worse perceived physical functioning and greater disability, respectively.CONCLUSION:Most employed patients returned to work within 1 year. LP patients resumed employment earliest, while PCDF patients returned to work latest, with greater disability at follow-up, suggesting that choice of surgical intervention may influence occupational outcomes.
KW - Cervical spondylotic myelopathy
KW - Complications
KW - Disability
KW - Patient-reported outcomes
KW - Randomized controlled trial
KW - Return to work
KW - Surgical outcomes
UR - http://www.scopus.com/inward/record.url?scp=85212991129&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000003048
DO - 10.1227/neu.0000000000003048
M3 - Article
C2 - 38912784
AN - SCOPUS:85212991129
SN - 0148-396X
VL - 96
SP - 131
EP - 141
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -