Introduction: Low back pain is a leading cause of work-related disability in the US and results in significant costs, including up to $20 billion annually due to lost productivity of the gainfully employed. Thus, return to work (RTW) is an important metric in the comparison of fusion versus decompression alone for grade 1 degenerative lumbar spondylolisthesis (DLS).

Methods: This was a retrospective analysis of a prospective registry. 599 patients underwent surgery for grade 1 DLS at twelve high-enrolling sites. Baseline variables were collected. Employment was defined as being employed and actively working or employed and on leave at time of surgery. RTW was assessed at 3 and 12 months following surgery.

Results: At baseline, 264 patients (44.1%) were employed. At baseline, there were a higher proportion of patients in the fusion cohort (219/462; 47.4%) that were employed compared with the decompression alone cohort (45/137; 32.8%; p=0.003). At 3 and 12 months, for patients eligible for RTW, 62.6% and 74.3%, respectively, were able to do so. In a subgroup analysis of the decompression alone cohort, 64.1% demonstrated RTW at 3 months with a rate that was similar at 12 months (65.0%) (p=0.94). In the fusion cohort, 62.3% demonstrated RTW at 3 months with rates that continued to increase at 12 months (75.8%) (p=0.01). There were no significant differences in RTW between the decompression alone and fusion cohorts at 3 and 12 months (p=0.83 and p=0.30, respectively).

Conclusions: At 12 months, the overall return to work rate was equivalent between the decompression and fusion cohorts. The decompression alone cohort reached peak RTW at 3 months, which remained stable at 12 months. Though the fusion cohort showed similar RTW at 3 months, the proportion continued to rise at 12 months. Further study is required to determine RTW rates in longer follow up.

Patient Care: This study demonstrates that patients receiving fusion for degenerative lumbar spondylolisthesis show increasing rates of return to work between 3 months and 12 months. On the other hand, patients undergoing decompression alone reach a plateau for return to work at 3 months. This data may aid preoperative counseling and expectation setting prior to surgery for degenerative lumbar spondylolisthesis.

Learning Objectives: By the conclusion of this session, participants should be able to 1) Understand that decompression alone and fusion for degenerative grade 1 lumbar spondylolisthesis is associated with similar rates of return to work 12 months following surgery 2) Identify that return to work trajectories differ by procedure, with those receiving fusion demonstrating higher rates of return to work at 12 months compared to 3 months. On the other hand, the decompression alone cohort demonstrated return to work rates that plateaued between 3 and 12 months.

References: Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU: Return to work after diskogenic fusion in workers’ compensation subjects. Orthopedics 38:e1065–e1072, 2015