Large Percentage of Patients return to work after Surgical treatment for Degenerative Cervocal Myelopathy

A recent article published in Acta Neurochirurgica by researches from Norway shows that at 12 months following surgery, 65% patients of degenerative cervical myelopathy had returned to work.

Degenerative cervical myelopathy (DCM) is a progressive spine disorder and the most common cause of spinal cord impairment in adults over 55 years. Degenerative changes in the cervical spine such as disk herniation, ligament hypertrophy or ossification, and osteophyte formation may lead to compression and dysfunction of the spinal cord. Symptoms of DCM include pain and stiffness in the neck, pain and numbness in limbs, poor coordination, imbalance, frequent falls, loss of dexterity, and incontinence. Several symptoms of DCM are non-specific and subtle and overlap with other neurological conditions, which makes early diagnosis a challenge. Lack of awareness and incomplete neurological assessment can also delay diagnosis, which may increase patients’ risk of developing life-long disability and impaired quality of life.

Neck and back pain are leading causes of absence from work. Recent studies examining outcomes after surgery for DCM found significant improvement for both mild, moderate, and severe DCM measured with several different patient-reported outcome measures (PROMs). Due to the high relevance for the individual and society, return to work (RTW) has become an important outcome measure in recent years. Few studies of high quality exist on RTW after surgery for DCM. As the working population continues to grow older and wishes to stay active and working, knowledge about RTW for patients with DCM is paramount.

In addition to pain, physical disability, and health related quality of life, RTW is increasingly acknowledged as a core outcome measure in spine surgery. Recent studies have shown considerable improved physical function after surgery for DCM which may provide new opportunities to patients who were previously unable to work. Although surgery for DCM results in statistical and clinical meaningful improvement, this is not a guarantee for returning to work.

The study by Lonne et al examined patterns for returning to work after surgery for DCM as well as predictors for achieving RTW. They found in total, 50% of the patients returned to work after 5 months, and by 12 months 65% of the patients had returned to work. At the end of the follow-up period at 36 months, 75% had returned to work, 5% less than the working percentage in the beginning of the follow-up period. Working pre-surgery was associated with RTW.

College education, female sex, and less than 90 days of sick leave in the year before surgery, as well as NDI and EQ-5D at 12 months, had the strongest effect on RTW in the study. Less than 90 days of sick leave in the year before surgery were associated with higher chances of RTW in their study, indicating that both manageable symptoms and a shorter symptom duration before surgery might contribute to achieving RTW.

Their study demonstratea that a large percentage of patients return to work after surgical treatment for DCM, suggesting it surgery as a safe and effective management option.

Reference:

Lønne, V.V., Hara, S., Gulati, S. et al. Return to work after surgery for degenerative cervical myelopathy: a nationwide registry-based observational study. Acta Neurochir 165, 779–787 (2023). https://doi.org/10.1007/s00701-023-05521-