Miranda Stephen P, Whitmore Robert G, Kanter Adam, Mummaneni Praveen V, Bisson Erica F, Barker Fred G, Harrop James, Magge Subu N, Heary Robert F, Fehlings Michael G, Albert Todd J, Arnold Paul M, Riew K Daniel, Steinmetz Michael P, Wang Marjorie C, Heller John G, Benzel Edward C, Ghogawala Zoher
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia , Pennsylvania , USA.
Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington , Massachusetts , USA.
Neurosurgery. 2025 Jan 1;96(1):131-141. doi: 10.1227/neu.0000000000003048. Epub 2024 Jun 24.
Return-to-work (RTW) is an important outcome for employed patients considering surgery for cervical spondylotic myelopathy (CSM). We conducted a post hoc analysis of patients as-treated in the Cervical Spondylotic Myelopathy Surgical Trial, a prospective, randomized trial comparing surgical approaches for CSM to evaluate factors associated with RTW.
In the trial, patients were randomized (2:3) to either anterior surgery (anterior cervical decompression/fusion [ACDF]) or posterior surgery (laminoplasty [LP], or posterior cervical decompression/fusion [PCDF], at surgeon's discretion). Work status was recorded at 1, 3, 6, and 12 months postoperatively. For patients working full-time or part-time on enrollment, time to RTW was compared across as-treated surgical groups using discrete-time survival analysis. Multivariate logistic regression was used to assess predictors of RTW. Clinical outcomes were compared using a linear mixed-effects model.
A total of 68 (42%) of 163 patients were working preoperatively and were analyzed. In total, 27 patients underwent ACDF, 29 underwent PCDF, and 12 underwent LP. 45 (66%) of 68 patients returned to work by 12 months. Median time to RTW differed by surgical approach (LP = 1 month, ACDF = 3 months, PCDF = 6 months; P = .02). Patients with longer length-of-stay were less likely to be working at 1 month (odds ratio 0.51; 95% CI, 0.29-0.91; P = .022) and 3 months (odds ratio 0.39; 95% CI, 0.16-0.96; P = .04). At 3 months, PCDF was associated with lower Short-Form 36 physical component summary scores than ACDF (estimated mean difference [EMD]: 6.42; 95% CI, 1.4-11.4; P = .007) and LP (EMD: 7.98; 95% CI, 2.7-13.3; P = .003), and higher Neck Disability Index scores than ACDF (EMD: 12.48; 95% CI, 2.3-22.7; P = .01) and LP (EMD: 15.22; 95% CI, 2.3-28.1; P = .014), indicating worse perceived physical functioning and greater disability, respectively.
Most employed patients returned to work within 1 year. LP patients resumed employment earliest, while PCDF patients returned to work latest, with greater disability at follow-up, suggesting that choice of surgical intervention may influence occupational outcomes.
对于考虑接受手术治疗脊髓型颈椎病（CSM）的在职患者而言，重返工作岗位（RTW）是一项重要的治疗结果。我们对脊髓型颈椎病手术试验中接受实际治疗的患者进行了事后分析，该试验是一项前瞻性随机试验，比较了CSM的手术方法，以评估与RTW相关的因素。
在该试验中，患者被随机分配（2:3）接受前路手术（颈椎前路减压/融合术[ACDF]）或后路手术（椎板成形术[LP]，或根据外科医生的判断进行颈椎后路减压/融合术[PCDF]）。术后1、3、6和12个月记录工作状态。对于入组时全职或兼职工作的患者，使用离散时间生存分析比较各实际治疗手术组的RTW时间。采用多变量逻辑回归评估RTW的预测因素。使用线性混合效应模型比较临床结果。
163例患者中有68例（42%）术前正在工作并接受分析。共有27例患者接受了ACDF，29例接受了PCDF，12例接受了LP。68例患者中有45例（66%）在12个月内重返工作岗位。RTW的中位时间因手术方式而异（LP = 1个月，ACDF = 3个月，PCDF = 6个月；P = 0.02）。住院时间较长的患者在术后1个月（优势比0.51；95%置信区间，0.29 - 0.91；P = 0.022）和3个月（优势比0.39；95%置信区间，0.16 - 0.96；P = 0.04）工作的可能性较小。在术后3个月时，PCDF组的简明健康状况调查36项身体成分汇总得分低于ACDF组（估计平均差异[EMD]：6.42；95%置信区间，1.4 - 11.4；P = 0.007）和LP组（EMD：7.98；95%置信区间，2.7 - 13.3；P = 0.003），且颈部残疾指数得分高于ACDF组（EMD：12.48；95%置信区间，2.3 - 22.7；P = 0.01）和LP组（EMD：15.22；95%置信区间，2.3 - 28.1；P = 0.014），分别表明身体功能感知较差和残疾程度较高。
大多数在职患者在1年内重返工作岗位。LP组患者最早恢复工作，而PCDF组患者最晚重返工作岗位，随访时残疾程度更高，这表明手术干预的选择可能会影响职业结局。
