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 two years of follow-up. The cohorts were compared at six weeks, one year, and two years. Results. – Of 173 matched patients (85 open, 88 cMIS), there were no significant differences in age, sex, or ASA classification. The average age was 68.2 years with ≥3 levels fused. The open group had significantly more direct posterior decompressions, a 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 six weeks, working patients were similar (14.1% vs. 15.9%, P=0.741); at one year, significantly more cMIS patients returned to work (10.5% vs. 21.5%, P=0.049). At two 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 six weeks and one year postoperatively. At two years, return-to-work remained higher for cMIS but this difference was no longer statistically significant.