Does Velocity of Return-to-Work Differ between Circumferential Minimally-Invasive and Open Surgery to Treat Adult Spinal Deformity?

Study Design. Retrospective matched cohort study Objective. We sought to compare circumferential minimally-invasive surgery (cMIS) to open deformity correction surgery on patients’ timing of return to work. Summary of Background Data. Adult spinal deformity (ASD) impacts functional ability and quality of life, often influencing patients’ ability to work. Surgical correction can improve alignment and symptoms; however, recovery timelines may vary depending on surgical technique. Methods. Prospectively collected data from the International Spine Study Group (ISSG) multicenter database was queried for ASD correction. Patients were evaluated in two cohorts: cMIS or open surgery. Propensity scoring matched age, body mass index, pelvic incidence–lumbar lordosis mismatch, and sagittal vertical axis. All patients had at least 2 year follow-up. The cohorts were compared at 6 weeks, 1 year, and 2 years. Results. Of 173 matched patients (85 open, 88 cMIS), there were no significant differences in age, gender, or ASA classification. Average age was 68.2 years with ≥3 levels fused. The open group had significantly more direct posterior decompressions, higher median number of transforaminal lumbar interbody fusions, longer surgery time, greater blood loss, and longer hospital stay. The cMIS group had a higher median number of lateral lumbar interbody fusions. Baseline work status did not differ significantly: disabled (4.7% vs. 6.8%), working(20.0% vs. 21.5%), retired (71.7% vs. 67.0%), not working (3.5% vs. 4.5%). At 6 weeks, working patients were similar (14.1% vs. 15.9%, P =0.741); at 1 year, significantly more cMIS patients returned to work (10.5% vs. 21.5%, P =0.049). At 2 years, more cMIS patients had returned to work (14.1% vs. 19.3%), but this was not significant ( P =0.277). Conclusion. Patients undergoing cMIS surgery returned to work at a higher rate between 6 weeks and 1 year postoperatively. At 2 years, return-to-work remained higher for cMIS but this difference was no longer statistically significant.