One of the most common questions from patients preparing for back surgery is, “when can I expect to return to work?” Most published postoperative restrictions are based upon theoretical risks to patients and on surgeon opinions with no consensus on the ‘right time’ to return to work.1-2 Although there are general guidelines for surgeons and patients, many factors need to be considered when making these recommendations, including a patient’s occupation, age, overall medical health, and baseline functional ability. The spinal condition being addressed as well as the complexity and length of the surgery being performed must also be considered. To help provide return to work expectations following lumbar spine surgery, low back surgeries are simplified to 2 broad categories: non-instrumented lumbar spine surgeries (NILSS) and instrumented lumbar spine surgeries (ILSS). For these 2 surgical categories, work activities are separated into:
- light duties (such as clerical work)
- medium to moderate duties (such as a nurse or truck/ fork-lift driver)
- heavy duty labor (such as construction and bricklaying)
NON-INSTRUMENTED LUMBAR SPINE SURGERY (NILSS)
Example surgeries in this category include microdiscectomies and laminectomy/decompressions. These surgeries are often performed through small incisions with short operating times and minimal blood loss, allowing most patients to be discharged home the same day. Patients can generally expect to resume light duty work activities around 2-4 weeks. More physical jobs with moderate work duties may have to wait a little longer, such as 4-6 weeks. Patients that need to perform more heavy duties may expect to return to work around 8 weeks, but this may be delayed to 12 weeks if surgery involves multiple spinal levels. Physical activities are then slowly increased with no limitations and a full return to work activities around 12-14 weeks from surgery.
INSTRUMENTED LUMBAR SPINE SURGERY (ILSS)
Example surgeries in this category include the placement of hardware to “fuse” spinal segments. These surgeries are generally performed through a large open incision, or several smaller minimally invasive incisions. Compared to NILSS, ILSSs are often longer, more complex, and require hardware placement (such as screws and grafts) to promote the bones to grow together. Depending on the type and extent of surgery (number of levels, etc.), some patients may go home the same day while others may require admission to the hospital for a few days. Recovery from ILSS is typically longer and more extensive than NILSS. For single level surgeries, patients can generally expect to resume light duty work activities around 2-4 weeks, with return to work for moderate duties around 6-8 weeks and 12 weeks for more heavier work duties. When patients undergo multi-level ILSS, the timeline for all work duties may be delayed to roughly 6 weeks for light duties, 8 weeks for medium duties, and 12-14 weeks for heavier labor duties. Similar to NILSS, patients can then expect to continue increasing their activities after 12-14 weeks.
Many patients are dependent on their income and may be eager to return to work in a shorter time frame than may be deemed reasonable by their surgeon1. It is important to remember that each patient is unique, thus any and all guidelines must be tailored to the individual patient’s goals and postoperative pain levels. It is recommended to have an open discussion about returning to work expectations before surgery to avoid surprises or misunderstandings while ensuring safety.
This article is from our Fall 2022 issue of the Spine Health Journal.