Occupational recovery after work-related AO Spine type A1 compression fractures: Association between treatment strategy and sick-leave duration.

Abstract

Return-to-work (RTW) is an important indicator of functional recovery after spinal trauma, yet occupational outcomes following stable thoracolumbar compression fractures remain poorly characterized. This study evaluated factors associated with sick-leave duration and occupational recovery in patients with work-related AO Spine type A1 vertebral compression fractures. This retrospective cohort study included adults with work-related AO Spine type A1 thoracolumbar compression fractures without neurological deficit treated at a tertiary referral center between 2007 and 2025. Patients underwent percutaneous vertebroplasty, orthopedic bracing, or posterior spinal arthrodesis. The primary outcome was sick-leave duration, defined as the interval between injury and resolution of work capacity. Multivariable linear regression using log-transformed sick-leave duration was performed to identify factors independently associated with occupational recovery. Seventy patients were included: 35 underwent vertebroplasty, 18 orthopedic bracing, and 17 spinal arthrodesis. Sick-leave duration differed significantly among treatment groups (p < 0.001). Median sick-leave duration was 62 days (IQR 38-94) after vertebroplasty, 144.5 days (IQR 112-186) after orthopedic bracing, and 178 days (IQR 120-327) after spinal arthrodesis. In multivariable analysis, treatment strategy remained independently associated with sick-leave duration. Compared with vertebroplasty, sick leave was approximately 2.2 times longer after orthopedic bracing and 3.1 times longer after spinal arthrodesis. Age and associated injury severity were not independently associated with sick-leave duration. Stratified analyses demonstrated a similar gradient in occupational recovery among patients without major associated injuries. In this cohort of work-related AO Spine type A1 vertebral compression fractures, treatment strategy was strongly associated with occupational recovery. Patients treated with vertebroplasty had shorter sick leave than those managed with orthopedic bracing or spinal arthrodesis. Because treatment allocation was non-randomized, these findings should be interpreted as associations rather than evidence of causality. Prospective studies incorporating standardized functional and occupational outcomes are needed to clarify the role of different treatment strategies.