Poorer Preoperative Function Leads to Delayed Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy

Background: The factors that affect return to work (RTW) after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) remain unclear, especially in a non-Workers' Compensation setting. We aimed to (1) identify factors that influence RTW in patients undergoing ACDF (2) determine if early RTW plays a role in functional outcomes, quality of life, and satisfaction. Methods: Prospectively collected data of 103 working adults who underwent primary ACDF for DCM were retrospectively reviewed. Patients were stratified into 2 groups: early RTW (<= 60 days, n = 42) and late RTW (>60 days, n = 61). Results: The mean time taken to RTW was 34.7 and 134.9 days in the early and late RTW groups. respectively (P < 0.001). The early RTW group had significantly better preoperative Japan Orthopaedic Association (JOA) score and Neck Disability Index (NDI) (P < 0.05) and showed a trend toward higher 36-Item Short Form Physical Component Summary (PCS) (P = 0.071). The early RTW group also had significantly better postoperative JOA, NDI, and PCS at 6 months and less arm pain along with a trend toward better NDI at 2 years (P = 0.055). However, there was no difference in the change in outcome scores and a similar proportion in each group attained the minimal clinically important difference for each metric. At 2 years, 85.7% and 77.0% were satisfied in the early and late RTW groups, respectively (P = 0.275). Conclusions: While working adults that RTW later tend to have poorer function preoperatively and up to 2 years postoperatively, surgeons may reassure them that they will likely experience the same degree of clinical improvement and level of satisfaction after ACDF.