title: Return to Work Rates After Single-level Cervical Fusion for Degenerative Disc Disease Compared With Fusion for Radiculopathy in a Workers' Compensation Setting.
abstract: METHODS
  A retrospective comparative cohort study.
  
  
  OBJECTIVE
  To compare return to work (RTW) rates for patients who underwent single-level cervical fusion for radiculopathy compared with fusion for degenerative disc disease (DDD) as an indication for surgery.
  
  
  BACKGROUND
  Studies have shown that workers' compensation subjects have less favorable surgical and functional outcomes compared with the general population. Cervical decompression and fusion have provided great results with relieving radicular symptoms. Fusion for DDD, however, remains controversial.
  
  
  METHODS
  We retrospectively collected data of 21 169 subjects with cervical comorbidities who filed their claims for work-related injuries with Ohio Bureau of Workers' Compensation (BWC) between 1993 and 2011. The primary outcome was whether subjects met RTW criteria within 3-year follow-up after fusion. The secondary outcome measures and data on presurgical characteristics and secondary outcomes of each cohort were also collected.
  
  
  RESULTS
  Successful RTW status was affected by a number of presurgical risk factors: DDD as an indication for surgery, age of more than 50 years, out of work for more than 6 months, psychological evaluation, opioid use, legal litigation, and permanent disability. The DDD group had lower rate of successful RTW status (50.9%) and was less likely to have a sustained RTW status (odds ratio = 0.61, 95% confidence interval: 0.48-0.79, P = 0.0001) compared with the radiculopathy group (successful RTW rate 62.9%). RTW rate within 1 year after surgery was lower in the DDD group (39.9%) compared with the radiculopathy group (53.1%; P = 0.0001). DDD patients were absent 112 days more on average after surgery compared with radiculopathy patients (P = 0.0003).
  
  
  CONCLUSIONS
  Cervical fusion for DDD is associated with lower rate of successful RTW status when compared with fusion for radiculopathy in a worker's compensation setting. The decision to include surgical intervention in the management plan of cervical DDD should be approached with caution as the surgical outcome might not necessarily lead to improved postsurgical functionality and achieve sustained early RTW.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedics, University Hospitals Case Medical Center, 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 (BWC), Columbus, OH.
authors.forename: Arnold R
authors.initials: AR
authors.lastname: Haas
authors.affiliation: Ohio Bureau of Workers' Compensation (BWC), Columbus, OH.
authors.forename: Rick
authors.initials: R
authors.lastname: Percy
authors.affiliation: Ohio Bureau of Workers' Compensation (BWC), 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, Cleveland, OH.
authors.forename: Nicholas U
authors.initials: NU
authors.lastname: Ahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000601:surgery; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000706:statistics & numerical data