Factors Associated with Return to Work Following Laminoplasty for Degenerative Cervical Myelopathy

Introduction: Laminoplasty (LP) is a surgical option to treat degenerative cervical myelopathy (DCM). It is not known which patient variables influence patient return to work (RTW) status following LP. The purpose of this study is to identify which patient factors are predictive of returning to work within 90 days of undergoing LP for DCM.

Methods: A retrospective cohort study was conducted using prospectively collected data from the Quality Outcomes Database. Adult patients undergoing primary elective LP for DCM, who were employed preoperatively, and documented RTW status were included. Exclusion criteria included concomitant cervical fusion/arthroplasty, multistage surgeries, and revision surgeries. Variables collected included patient age, body mass index, sex, insurance status, education, race, smoking status, medical comorbidities, symptom duration, ASA grade, pain medication use, and baseline patient-reported outcomes (PROs), including neck and arm Visual Analog Scale pain scores, neck disability index (NDI), and modified Japanese Orthopedic Association (mJOA) scores. The primary outcome of interest was RTW status at 90 days following LP. Bivariate analysis was conducted to compare baseline patient variables of those who returned to work within 90 days to those who did not. Cox regression analysis was conducted to identify predictors of time to RTW.

Results: Of 71 patients meeting inclusion criteria, 48 (67.6%) returned to work within 90 days, while 23 (32.4%) either returned after 90 days or did not return to work. Patients who returned to work within 90 days had significantly lower preoperative NDI scores (23.7±17.5 vs. 35.6±14.3, p=0.008) and significantly higher preoperative mJOA scores (13.7±2.5 vs.12.2±2.7, p=0.018) compared to those who did not return to work. No differences were found in other baseline PROs. On Cox regression analysis, higher preoperative mJOA scores were significantly associated with truncated time to RTW (HR=1.14, 95%CI=1.01–1.29, p=0.034).

Conclusion : Patients who underwent LP for DCM with better preoperative NDI and mJOA scores were significantly more likely to return to work within 90 days. Higher baseline mJOA score was a significant independent predictor of returning to work at a quicker rate. These findings highlight the importance of pre-operative functional status in predicting a patient’s RTW status following LP.