Retrospective cohort comparative study.
To evaluate presurgical and surgical factors that affect return to work
(RTW) status after multilevel cervical fusion
, and to compare outcomes after multilevel cervical fusion
for degenerative disc disease
(DDD) versus radiculopathy
Summary of Background Data. Cervical fusion
provides more than 90% of symptomatic relief for radiculopathy
and myelopathy. However, cervical fusion
for DDD without radiculopathy
is considered controversial. In addition, multilevel fusion
is associated with poorer surgical outcomes
with increased levels fused.
Data of cervical comorbidities was collected from Ohio Bureau of Workers’ Compensation
for subjects with work-related injuries. The study population included subjects who underwent multilevel cervical fusion
. Patients with radiculopathy
or DDD were identified. Multivariate logistic regression was performed to identify factors that affect RTW status. Surgical and functional outcomes
were compared between groups.
Stable RTW status within 3 years after multilevel cervical fusion
was negatively affected by: fusion for DDD, age > 55 years, preoperative opioid use
, initial psychological evaluation before surgery, injury-to-surgery > 2 years and instrumentation.
DDD group had lower rate of achieving stable RTW status (P= 0.0001) and RTW within 1 year of surgery (P= 0.0003) compared with radiculopathy group. DDD patients were less likely to have a stable RTW status [odds ratio, OR = 0.63 (0.50–0.79)] or RTW within 1 year after surgery [OR = 0.65 (0.52–0.82)].
DDD group had higher rate of opioid use (P= 0.001), and higher rate of disability after surgery (P= 0.002).
Multiple detriments affect stable RTW status after multilevel cervical fusion
including DDD. DDD without radiculopathy
was associated with lower RTW rates, less likelihood to return to work
, higher disability
, and higher opioid use
after surgery. Multilevel cervical fusion
for DDD may be counterproductive. Future studies should investigate further treatment options of DDD, and optimize patient selection criteria for surgical intervention.
Level of Evidence: 3