Return to work after lumbar microdiskectomy – a systematic review and meta-analysis

Study Design: Systematic review and meta-analysis. Objective: To investigate evidence on the prevalence and timeline of RTW after lumbar microdiskectomy. Summary of Background Data: While lumbar microdiskectomy is a widely used and well-studied procedure, there is lack of evidence on the postoperative prevalence and schedule of return to work after this type of surgery. Methods: Search at Medline, Embase, Cinahl, Scopus and Web of Science. Assessment of risk of systematic bias using Quality in Prognosis Studies (QUIPS). Random effects meta-analysis and meta-regression. Adults undergoing lumbar microdiskectomy due to degenerative disc herniation, excluding spinal stenosis, percutaneous diskectomy, artificial disk, arthroplasty, laminectomy, fusion or symptoms of cauda equina. Results: Of identified 2,285 records, 31 were included in meta-analysis. Most of the studies had low risk of systematic bias. Pooling 21 studies, the mean prevalence of postoperative return to work was 78% (95% CI 71% to 83%). Pooling 13 studies the mean time of return to work was 4.79 (95% CI 3.88 to 5.70) weeks. The meta-regression of prevalence of return to work by the duration of follow-up resulted in significant but small coefficient of 0.02 (95% CI 0.01 to 0.03, P =0.006). There was considerable heterogeneity for all three models. Conclusion: The results of this review suggest that approximately 70%-80% of patients who undergo a microsurgical procedure for disc herniation return to work within the first month and a half. It also seems that returning to work after this period is quite unlikely. The duration of preoperative symptoms did not affect significantly the prevalence of RTW. Information about these trends should be taken into account both in the planning phase of the procedure and in setting goals for postoperative rehabilitation.