Return to Work After Surgery for Degenerative Cervical Myelopathy: Prospective Data From a Swedish Nationwide Cohort of 789 Patients

Background and objectives: Degenerative cervical myelopathy (DCM) is a progressive disorder that leads to significant neurological deficits, often requiring surgical decompression to prevent further decline. There are only a handful of studies analyzing return-to-work (RTW) outcomes after cervical spine surgery for DCM. This study seeks to elucidate RTW outcomes and to identify predictors preventing RTW in patients surgically treated for DCM in a nationwide prospective registry. Methods: A nationwide cohort analysis was conducted using prospectively gathered data from patients surgically treated for DCM, from the Swedish Spine Registry. Patients with documented postoperative outcomes focusing on RTW rates from 1 to 5 years were included. To identify predictive factors affecting RTW at 1 year postoperatively, separate univariable and multivariable logistic regression models were developed, incorporating demographic, functional and clinical, as well as preoperative and postoperative data and occupational characteristics. Results: A total of 789 patients were included with an average age of 52 years, with most patients working in moderate intensity jobs and nearly half were on sick leave before surgery. Most surgeries were elective, using an anterior approach. The RTW rate at 1 year was 76%, separating into 54% who had resumed full-time employment and 23% who had returned to a part-time capacity. In this cohort, 24% had not returned to work at the 1-year mark. Older age, physically demanding work, higher preoperative Neck Disability Index Score, reduced walking distance, and sickness benefits were significant predictors of a lack of RTW. Conclusion: 75% of the patients surgically treated for DCM returned to work within 1 year. Higher age, physically demanding work, higher Neck Disability Index Score, and full-time sickness benefits were all associated with a decreased likelihood of RTW. Recognizing these risk factors can help identify patients who may benefit from additional physical therapy, behavioral interventions, counseling, or work-place adjustments to support RTW.