title: Return to Work and Multilevel Versus Single-Level Cervical Fusion for Radiculopathy in a Workers' Compensation Setting.
abstract: METHODS
  Retrospective comparative cohort study.
  
  
  OBJECTIVE
  Examine the impact of multilevel fusion on return to work (RTW) status and compare RTW status after multi- versus single-level cervical fusion for patients with work-related injury.
  
  
  BACKGROUND
  Patients with work-related injuries in the workers' compensation systems have less favorable surgical outcomes. Cervical fusion provides a greater than 90% likelihood of relieving radiculopathy and stabilizing or improving myelopathy. However, more levels fused at index surgery are reportedly associated with poorer surgical outcomes than single-level fusion.
  
  
  METHODS
  Data was collected from the Ohio Bureau of Workers' Compensation (BWC) between 1993 and 2011. The study population included patients who underwent cervical fusion for radiculopathy. Two groups were constructed (multilevel fusion [MLF] vs. single-level fusion [SLF]). Outcomes measures evaluated were: RTW criteria, RTW <1year, reoperation, surgical complication, disability, and legal litigation after surgery.
  
  
  RESULTS
  After accounting for a number of independent variables in the regression model, multilevel fusion was a negative predictor of successful RTW status within 3-year follow-up after surgery (OR = 0.82, 95% CI: 0.70-0.95, P <0.05).RTW criteria were met 62.9% of SLF group compared with 54.8% of MLF group. The odds of having a stable RTW for MLF patients were 0.71% compared with the SLF patients (95% CI: 0.61-0.83; P: 0.0001).At 1 year after surgery, RTW rate was 53.1% for the SLF group compared with 43.7% for the MLF group. The odds of RTW within 1 year after surgery for the MLF group were 0.69% compared with SLF patients (95% CI: 0.59-0.80; P: 0.0001).Higher rate of disability after surgery was observed in the MLF group compared with the SLF group (P: 0.0001) CONCLUSION.: Multilevel cervical fusion for radiculopathy was associated with poor return to work profile after surgery. Multilevel cervical fusion was associated with lower RTW rates, less likelihood of achieving stable return to work, and higher rate of disability after surgery.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Mhamad
authors.initials: M
authors.lastname: Faour
authors.affiliation: Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Anderson
authors.affiliation: Ohio Bureau of Workers' Compensation, Columbus, OH.
authors.forename: Arnold R
authors.initials: AR
authors.lastname: Haas
authors.affiliation: Ohio Bureau of Workers' Compensation, Columbus, OH.
authors.forename: Rick
authors.initials: R
authors.lastname: Percy
authors.affiliation: Ohio Bureau of Workers' Compensation, Columbus, OH.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Woods
authors.affiliation: New Hampshire NeuroSpine Institute, Bedford, NH.
authors.forename: Uri M
authors.initials: UM
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Nicholas U
authors.initials: NU
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D062707:Return to Work; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000191:economics