What factors predict return to work after surgery for grade 1 lumbar spondylolisthesis? A 5-year Spine CORe™ analysis of QOD data.
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2026-05
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Unemployment following surgery incurs significant societal costs. The authors aimed to identify predictors of return to work (RTW) following surgery for patients with grade 1 lumbar spondylolisthesis. This Spine CORe™ study is a post hoc analysis of prospectively collected data from the Quality Outcomes Database (QOD) grade 1 lumbar spondylolisthesis module. Patients were divided into 2 groups: employed preoperatively and unemployed preoperatively. Univariate and multivariate instruments were used to identify predictors of RTW/employment within 5 years postoperatively. Across the 12 highest enrolling QOD sites (Spine CORe™ group), 608 patients were enrolled with 81% having Oswestry Disability Index (ODI) follow-up data. Of these 608 patients, 604 patients had baseline employment status recorded. Of 275 patients who were employed preoperatively, 249 had RTW follow-up data. Of the 329 patients unemployed preoperatively, 218 had RTW follow-up data. The study cohort follow-up for RTW was 77%. By 5 years postoperatively, 87.1% (n = 217) of those employed preoperatively and 22.0% (n = 48) of those unemployed preoperatively returned to work. In each cohort, there were no differences in age, sex, BMI, and American Society of Anesthesiologists class between those who did and those who did not RTW. These results remained consistent in the subgroup analysis of patients younger than 65 years at baseline. However, the only difference observed in this age group was within the preoperatively unemployed cohort, where the RTW group had a lower BMI (28.4 ± 5.5 vs 32.8 ± 9.0, p = 0.001). On multivariate analysis for the preoperatively employed cohort, college degree (OR 3.6, 95% CI 1.3-12.2) and active employment (OR 6.0, 95% CI 1.9-19.8) remained independent predictors of returning to work. For those preoperatively unemployed, a college degree (OR 2.2, 95% CI 1.1-4.4) independently predicted RTW. Approximately 87% of patients employed preoperatively RTW, and 22% of patients unemployed preoperatively returned to the workforce within 60 months after surgery for grade 1 spondylolisthesis. College-level education independently predicted RTW for both preoperatively employed and preoperatively unemployed patients.
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Yee, Timothy J, Vardhaan S Ambati, Jay Kumar, Swetha Atluri, Catherine Ravikumar, Arati Patel, Anthony DiGiorgio, Paul K Kim, et al. (2026). What factors predict return to work after surgery for grade 1 lumbar spondylolisthesis? A 5-year Spine CORe™ analysis of QOD data. Neurosurgical focus, 60(5). p. E21. 10.3171/2025.12.focus25961 Retrieved from https://hdl.handle.net/10161/34622.
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Christopher Ignatius Shaffrey
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
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