A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques

Abstract

BackgroundChronic low back pain is a common health problem for adult workers and causes an enormous economic burden. With the improvement of minimally invasive surgical techniques (MIS) in spinal fusion and the development of fusion devices, more lumbar operations are today being performed through a less invasive technique. When compared with open surgeries (OS), MIS has demonstrated better clinical outcomes including operation time, blood loss, complication rates and length of hospital stay. The aim of this review was to identify and summarize evidence on the time to return to work and the duration of post-operation narcotic use for patients who had lumbar spinal fusion operations using MIS and OS techniques.MethodsA systematic literature review was performed including studies identified from PubMed, EMBASE, the Cochrane Collaboration, and the Centre for Review and Dissemination (CRD) (January 2004–April 2014) for publications reporting on time to return to work and post-operation narcotic use after MIS or OS lumbar spinal fusion surgeries.ResultsOut of a total of 36 included studies, 28 reported on the time to return to work and 17 on the narcotic use after MIS or OS. Four studies described the time to return to work directly comparing MIS and OS. Three studies, from the US, directly compared the duration of narcotic use between MIS- transforaminal lumbar interbody fusion (TLIF) and OS-TLIF. In addition to the time to return to work, 23 studies reported on the rate of return to work and the employment rate before and after surgery, and two Swedish studies presented sick leave data.ConclusionsThere is a gap of good quality data describing the time to return to work and narcotic use after lumbar spinal fusion operations using MIS or OS techniques. However, the current systematic literature review indicates that patients who have lumbar spinal fusion operations, with the MIS procedure, generally return to work after surgery more quickly and require less post-operation narcotics for pain control compared to patients who have OS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2398-6) contains supplementary material, which is available to authorized users.

Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis

“…This is remarkable given the importance of participation in sports and work for patients after orthopaedic surgery,5 6 especially for patients who are of working age for whom resumption of societal participation is an important treatment goal. Moreover, return to sports and work is typically delayed and/or not successful for many of these patients 7–11. For instance, patients undergoing joint replacement surgery considered advice regarding participation to be inconsistent and not tailored to their individual circumstances, which often left them with the feeling that they would have been able to recover sooner than what they had actually accomplished 5…”

Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

“…The use of and indications for MISS are gradually increasing in spine deformity surgery. Compared with traditional thoracolumbar open surgery for deformity correction, minimally invasive surgical approaches provide benefits to reduce approach-related tissue injury, intraoperative blood loss, and surgical site infection [ 6 , 43 ]. Several studies have reported favorable surgical MISS outcomes for treatment of adult spinal deformities as well as adolescent idiopathic scoliosis and neuromuscular scoliosis [ 3 , 43 , 44 ].…”

“…With its aim of minimizing surgical morbidity and achieving the same surgical outcomes as traditional open spine procedures, MISS is advocated when possible to avoid excessive approach-related injury and subsequent preservation of the normal anatomy while allowing rapid recovery as well as a better quality of life [ 1 - 4 ]. Many studies have reported that patients treated with MISS experienced lower intraoperative and perioperative adverse outcomes, shorter operative time, and a faster return to work [ 4 - 6 ].…”

Using minimally invasive techniques adds to the value equation for select patients

“…Recent studies have shown that utilizing minimally invasive spine surgery (MISS) may potentially be more cost-effective than utilizing open techniques (8)(9)(10)(11). Though knowledge is still expanding in regards to the various advantages of MISS, MISS has been purported to result in shorter operative times, shorter hospital length of stay, and faster return to activities of daily living compared to open spine surgical techniques (12)(13)(14)(15)(16). Furthermore, they lead to less muscle/tissue damage, less estimated blood loss (EBL), perioperative pain, and narcotics usage post-operatively (12)(13)(14)(15)(16).…”

“…Though many studies have explored the clinical outcome benefits of MISS compared to open techniques as discussed above, the topic of return to activities of daily living, such as return to work, has not been as thoroughly analyzed. Recently, however, Wang et al conducted a systematic literature review that compared time to return to work and narcotic use in patients who underwent lumbar spinal fusion using minimally invasive or open techniques (16). In their analysis, of the four studies that directly compared return to work and narcotics use between minimally invasive and open TLIFs, three showed that patients who underwent MI-TLIF returned to work significantly earlier and at a significantly greater rate compared to those who underwent open TLIF.…”