Review ArticleReturn to work following surgery for lumbar radiculopathy: a systematic review
Introduction
Lifetime prevalence rates of low back pain in the general population range from 50% to 90% [1], [2], [3], of which 5%–10% suffer from back pain-associated leg pain [3]. In these patients presenting lumbar radiculopathy, surgical intervention is often indicated, in particular when conservative treatments fail and symptoms keep on aggravating [4], [5], [6], [7].
Surgeries for lumbar radiculopathy are often associated with high indirect costs related to absenteeism from work [8], [9], leading to high socioeconomic burden [8], [10], especially when patients present a suboptimal response to surgery. In this view, return to work (RTW) is an important outcome measure, which should be considered when deciding on the surgical intervention. However, RTW is also influenced by a range of both patient-related as well as external factors [9], [11], making it a complicated outcome to interpret.
One of the most consistent predictors of RTW in patients with low back disability is the recovery expectation of the patient [12]. High expectancies on work resumption is a strong predictor for effectively resuming work [13]. On the other hand, unrealistic expectations of surgical outcome lead to lower levels of satisfaction [14], with a negative impact on therapy compliance [15], and consequently on recovery. Informing patients in an adequate way will result in realistic expectancies about recovery and RTW. This emphasizes the need for a clear overview of RTW expectations following surgery for lumbar radiculopathy. Moreover, identifying factors positively or negatively related to or predicting work resumption could foster perioperative interventions focusing to manipulate this process in a positive way.
Therefore, the primary aim of this systematic review is to give an overview of the duration of sick leave and RTW rates after different surgical techniques for lumbar radiculopathy. The secondary aim is to screen the included articles for factors related to or predicting RTW.
Section snippets
Protocol and registration
This systematic review is reported in accordance with the PRISMA statement (Preferred Reporting Items for Systematic reviews and Meta-Analysis) [16]. The protocol was registered a priori in the PROSPERO database under the following registration number: CRD42016035300.
Search strategy
Four electronic databases were searched: PubMed, Web of Science, SCOPUS, and EMBASE. No limits were applied and the last search was completed on April 24, 2017.
Research questions were composed using the PICO (Population,
Study selection
The systematic search resulted in 4,890 unique studies to be considered for screening, of which 63, comprising 79 study arms, were included in this systematic review (Figure). The most important reasons for exclusion were non-eligible population (eg, patients without leg pain, with spondylolisthesis, with vertebral fractures), different intervention (eg, no surgery was performed, other interventions apart from usual care), and different outcome. Percentage agreement between both blinded
Discussion
The present systematic review shows that the surgical technique plays a role in RTW outcomes, as all studies comparing less invasive techniques with conventional open surgery show results favoring the former. Preoperative work status, presence of comorbidities, age, sex and duration of preoperative symptoms predict RTW following lumbar surgery. Duration of postoperative sick leave can be predicted by the preoperative level of pain or disability and presence of symptoms of depression,
Conclusion
Diverse results were found for RTW duration and RTW rates following surgery for lumbar radiculopathy. Clinicians should consider several predictors and other factors related to work resumption when estimating and communicating about patients' RTW outcomes. The most important predictors for work resumption were preoperative work status, presence of comorbidities, age, sex, duration of preoperative symptoms. Those for duration of sick leave were preoperative level of pain or disability, the
Acknowledgments
Eva Huysmans and Lisa Goudman are PhD research fellows of the Agency for Innovation by Science and Technology (IWT)—Applied Biomedical Research Program (TBM), Belgium. Kelly Ickmans is a postdoctoral research fellow of the Agency for Innovation by Science and Technology (IWT)—Applied Biomedical Research Program (TBM), Belgium. Maarten Moens is a clinical investigator and received the Lyrica Independent Investigator Research Award (LIIRA). He received consultancy or speaker honoraria from
References (89)
- et al.
An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy
Spine J
(2014) - et al.
Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model
Pain
(2004) - et al.
Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults: a retrospective matched cohort study
World Neurosurg
(2016) - et al.
Comparison of usual surgical advice versus a nonaggravating six-month gym-based exercise rehabilitation program post-lumbar discectomy: results at one-year follow-up
Spine J
(2006) - et al.
The Professional Athlete Spine Initiative: outcomes after lumbar disc herniation in 342 elite professional athletes
Spine J
(2011) - et al.
Efficacy of percutaneous laser disc decompression for radiculalgia due to lumbar disc hernia (149 patients)
Presse Med
(2007) - et al.
The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy
Pain
(1999) - et al.
Minimally invasive surgical approaches to gastric resection
Surg Clin North Am
(2017) - et al.
KNGF-Richtlijn lage Rugpijn
(2013) - et al.
Low back pain in primary care: costs of care and prediction of future health care utilization
Spine
(2010)
Diagnosis and treatment of sciatica
BMJ
Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain
Pain Physician
Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the Cochrane collaboration
Spine
Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review
Eur Spine J
The economic impact of failed back surgery syndrome
Br J Pain
Systematic review of prognostic factors for return to work in workers with sub acute and chronic low back pain
J Occup Rehabil
Economic burden of back and neck pain: effect of a neuropathic component
Popul Health Manag
Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review
Eur Spine J
Do expectancies of return to work and job satisfaction predict actual return to work in workers with long lasting LBP?
BMC Musculoskelet Disord
The evaluation of the surgical management of nerve root compression in patients with low back pain: part 2: patient expectations and satisfaction
Spine
The characteristics of patient satisfaction measures
Spine
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration
J Clin Epidemiol
The well-built clinical question: a key to evidence-based decisions
ACP J Club
Evaluation of PICO as a knowledge representation for clinical questions
AMIA Annu Symp Proc
Rayyan—a web and mobile app for systematic reviews
Syst Rev
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions
J Epidemiol Community Health
Three-year postoperative outcomes between MIS and conventional TLIF in 1-segment lumbar disc herniation
Minim Invasive Ther Allied Technol
A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect
Spine
Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up
Eur Spine J
Functional outcome of lumbar discectomy by fenestration technique in lumbar disc prolapse—return to work and relief of pain
J Clin Diagn Res
Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions
Spine
Are postoperative activity restrictions necessary after posterior lumbar discectomy? A prospective study of outcomes in 50 consecutive cases
Spine
Pars interarticularis fenestration in the treatment of foraminal lumbar disc herniation: a further surgical approach
Neurosurgery
Does the outcome 2 months after lumbar disc surgery predict the outcome 12 months later?
Disabil Rehabil
A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy
J Bone Joint Surg Am
Microdiscectomy or tubular discectomy: is any of them a better option for management of lumbar disc prolapse
J Craniovertebral Junction Spine
Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach
Pain Physician
Minimal incision, multifidus-sparing microendoscopic diskectomy versus conventional microdiskectomy for highly migrated intracanal lumbar disk herniations
J Am Acad Orthop Surg
Clinical outcome of full-endoscopic interlaminar discectomy for single-level lumbar disc herniation: a minimum of 5-year follow-up
Pain Physician
Effects of lumbar disk herniation on the careers of professional baseball players
Orthopedics
Posterior endoscopic discectomy: results in 300 patients
Indian J Orthop
Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse
Eur Spine J
Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial
Eur Spine J
Percutaneous endoscopic discectomy: clinical results and how it affects the quality of life
J Spinal Disord Tech
Cited by (27)
Systematic Review and Meta-Analysis of Predictors of Return to Work After Spinal Surgery for Chronic Low Back and Leg Pain
2022, Journal of PainCitation Excerpt :If any hypotheses-driven studies presented only unadjusted analyses or investigated broad classes of multiple predictors, they were classified as phase-1. Following the recommendations by Huguet et al,34 the starting quality rating could be downgraded for severe study limitations (due to dominant evidence from high RoB studies or unadjusted analyses), clinically meaningful inconsistency in the effect estimates, indirectness (eg, if it was not possible to verify chronic pain status of all included participants), imprecision (due to inadequate sample size or insufficient results reporting), and publication bias (if certain relationship was investigated in <4 studies); and upgraded if moderate (OR ≥2.5 or ≤0.4) or large (OR ≥4.25 or ≤0.24) effect size, or ‘dose’ effect (where higher levels of the predictor would lead to greater effect sizes) were present, resulting in an overall quality rating. We screened 2,622 unique records and their flow through the selection process is illustrated in Figure 1.
Occupational Medicine and Vocational Rehabilitation
2020, Braddom's Physical Medicine and RehabilitationReturn to work after surgery for lumbar disc herniation, secondary analyses from a randomized controlled trial comparing supervised rehabilitation versus home exercises
2020, Spine JournalCitation Excerpt :The duration of sick leave was not affected by participating in postoperative supervised rehabilitation. The length of sick leave reported in this study are consistent with current literature as presented by Huysmans et al.[11]. However significant variation exists in the published literature, as recommendations of physical restrictions after surgery are very heterogeneous.
Effects of Workload on Return to Work After Elective Lumbar Spine Surgery
2024, Global Spine Journal
FDA device/drug status: Not applicable.
Author disclosures: EH: Fellowship Support: Agency for Innovation by Science and Technology (IWT)—Applied Biomedical Research Program (TBM), project n° 150180 (G), outside the submitted work. LG: Fellowship Support: Agency for Innovation by Science and Technology (IWT)—Applied Biomedical Research Program (TBM), project n° 150180 (G), outside the submitted work. GVB: Nothing to disclose. MDJ: Nothing to disclose. MM: Consulting: Medtronic, Pfizer; Speaking and/or Teaching Arrangements: Medtronic, Pfizer (B), outside the submitted work. JN: Nothing to disclose. KI: Fellowship Support: Agency for Innovation by Science and Technology (IWT)—Applied Biomedical Research Program (TBM), project n° 150180 (G), outside the submitted work. RB: Nothing to disclose. CV: Nothing to disclose. KP: Nothing to disclose.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
There are no conflict of interest disclosures from any authors.