Return to work rate and long-term effectiveness of delayed versus early surgery for back pain and sciatica in Russian Railways employees: a single-center retrospective study.

Abstract

Retrospective study. To evaluate the return-to-work rate and long-term outcomes of delayed versus early surgery for back pain and sciatica among railway workers. The timing of conservative versus surgical treatment and their long-term clinical effectiveness remain controversial. To our knowledge, there are no studies on the long-term postoperative outcomes and risk factors for unsatisfactory long-term clinical outcomes after conservative and surgical treatment of lumbar degenerative diseases in railway workers. We identified patients with persistent back pain and sciatica due to lumbar degeneration at L4-L5 or L5-S1 treated between 2010 and 2020. Two groups of patients were identified: The Delayed group (n=692) initially refused operative care despite 6-12 weeks of non-operative care, and the Early group (n=1,687) underwent surgery immediately after routine (6-12 weeks) non-operative care was unsuccessful. Perioperative clinical data and return-to-work rates were obtained before surgery and at a minimum of 40 months postoperatively. Factors associated with unfavorable outcomes were also identified. At baseline, the two groups had comparable clinical data, demographics, and workload intensity. There were significantly better clinical results, fewer complications, and a higher frequency of return to work in the Early group than in the Delayed group (p<0.05); 15.3% (209) and 25.7% (147) of the patients in the Early and Delayed groups, respectively, had unsatisfactory long-term clinical outcomes. Specific factors associated with unsatisfactory long-term clinical outcomes in the delayed surgery group were male sex, diabetes mellitus, lower extremity pain Visual Analog Scale >40 mm, Oswestry Disability Index >48%, physical component score <18 points, preoperative use of narcotic analgesics, and light-to-medium and heavy-to-very heavy preoperative workload. In this single-center study involving railway workers with lumbar degenerative back pain and sciatica, early surgery was superior to delayed surgery in terms of pain intensity, functional status, quality of life, return-to-work rate, and reoperation rate at the long-term follow-up. Further prospective studies with larger sample sizes are required to clarify this association.