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Medical Factors
Why do Spinal Surgeons who have spine surgery get back to work quickly?

At a glance:
This study investigated the number of spine surgeons that undergo spine surgery and the outcomes of their treatment.

  • A surprisingly high proportion of the surgeons surveyed in this study had undergone surgery on their spine (almost 1 in 5).Although a larger number of the members of the North American Spine Society had surgery than did members of the Canadian Orthopaedic Association, they had strikingly similar patterns in returning to work.
  • Spinal surgeons are a highly motivated, self-employed group who missed little work before and after having surgery. The majority of surgeons who had spinal surgery were back at work within four weeks of the operation, regardless of what type of spinal operation was performed. They returned to less physical duties, such as seeing patients.
  • Return to the more physically demanding activity of operating was slower if the operation was a spinal fusion
    spinal fusion
    Spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which should decrease pain from the joint. A bone graft is added to an area of the spine, which grows between the two vertebrae
    vertebrae
    (singular: vertebra) The individual irregular bones that make up the spinal column.
     and fuses them together. The operation may also include insertion of metal rods to help join the bones.
     (surgical joining of two or more vertebrae); 42% were back performing surgery within 4 weeks compared to 65% of those who had a spinal decompression
    decompression
    Surgical procedure that is performed to alleviate pain caused by pinched nerves. A small portion of the bone over the nerve root and/or disc
    disc
    A 'cushion' between vertebrae in the spine. Each disc helps form a joint to allow movement between the vertebrae.  Disks
    disk
    A 'cushion' between vertebrae in the spine. Each disc helps form a joint to allow movement between the vertebrae. Disks have a fibrous outer layer surrounding a jelly-like core, which functions to absorb impact in the spine. Alternative spelling: disc.
      have a fibrous outer layer surrounding a jelly-like core, which functions to absorb impact in the spine. Alternative spelling: disk.
     material from under the nerve root is removed to give the nerve root more space and help it heal.
     operation (surgery to alleviate pain caused by pinched nerves).
Perspectives:
Employee
Spinal surgeons who have surgery performed on their own spines take little time away from work, both before and after surgery. They also have surgery much more frequently than the rest of the population.

Their short time off work before surgery, brief rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 and rapid return to work after surgery may be a result of confidence in their thorough knowledge of the spine, the disease and the treatment, which reduces their worries about surgery, helps them to recover quickly and decreases disability.

Being self-employed, spine surgeons are also in a good position to control the pace of their return to work. This allows them to recover while working and minimise disruption to their normal lives.

This study shows that if you have to have surgery, having a thorough understanding of your spine, the medical condition, and the quickest way to get back to normal activity, is important for your confidence in making a full recovery. Consult your doctor and specialists about getting the information you need.

Discuss with your employer and insurer your needs after the operation, so that when you return to work you are in control of your work environment and hours. This will enable you to return to your normal life and good health as early as possible.
Employer
If an employee wants to return to work as soon as possible after spinal surgery, provide them with work that is as close as possible to their normal job given the constraints of their condition, but also allow them to modify their own work duties and hours if necessary.

Consult with the employee, their doctors and their fellow workers to create shared understanding and a team approach to the employee's return to work.
Treater
This study shows that it is normal to return to work following spinal surgery, and surgeons themselves return to work within a short time after an operation. A number of factors effect how quickly a person will return to work after surgery. Surgeons may be quick to return to work because they have control over work activities, a deep understanding of the condition, a strong work ethic and/or motivation to manage their practice.

What this study does show is that return to work can occur early in the recovery phase following surgery. This will be aided by:

  • Ensuring that patients have the best possible understanding of their medical condition.
  • Advising patients to return to work early.
  • Provision of appropriate return to work tasks by the patient's employer.
  • Good communication between patient, employer and doctor, thus allowing the patient having control over their return to work by specifying what they are able to do.
Insurer
This study shows that return to work following spinal surgery should be supported and encouraged.

Return to work can occur early in the recovery phase following surgery. This will be more successful when:

  • Patients have the best possible understanding of their medical condition.
  • Early return to work is supported and encouraged by doctors, employers and insurers.
  • Work duties are appropriately modified by the employer on return to work.
  • Return to work is arranged with the employee's input, ensuring they feel they are able to discuss any concerns.
  • The employee feels a sense of control over the activities performed when they return to work.
Original Article, Authors & Publication Details:
H. Hall1, G. McIntosh1, T. Melles1, and A. A. White III2.

Outcomes of surgeons who have undergone spine surgery. Journal of Spinal Disorders; 10(6): 518-521

1Canadian Back Institute, Toronto, Ontario, Canada

2Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A.
Background, Study Objectives, How It Was Done:
The advice given to patients regarding return to work after spinal surgery has varied, so the authors of this study looked at how doctors manage their own recovery. The aim of this study was to find out how soon spine surgeons returned to work after a back operation.

A multiple choice questionnaire with 25 questions was mailed to all 842 members of the Canadian Orthopaedic Association and the 792 members of the North American Spine Society. The response rate from the Canadians was 46% (384), and from the Americans was also 46% (351).Five Canadians and 14 Americans who completed the questionnaire were not surgeons and were excluded from the study analysis. Therefore, 379 Canadian and 337 American surgeons in total were followed in the study.
Study Findings:
There was no statistically significant difference between the two groups' average age, gender distribution, and percentage of specialists.

Of those who replied to the survey (both Canadian and American), 17% had undergone spinal surgery.

49 Canadians and 74 Americans had undergone spinal operations. Taking into account those who did not complete the questionnaire (and assuming that most had not had spinal surgery), this means 59 in 1,000 Canadian spine surgeons and 98 in 1,000 U.S. spine surgeons have had an operation on their spine. From this information, the authors estimate that 8 in 1,000 people in Canada and 42 in 1,000 people in the U.S. have had spinal surgery.

76% of the total number of respondents missed less than 2 weeks of work before having surgery.

After surgery:

  • 71% returned to practice within 4 weeks
  • 56% resumed performing surgery within 4 weeks
  • 19% attended physical therapy

The table below lists the type of operations that had been performed on the surgeons.

Percentage of types of spinal surgery performed on respondents
  Canadian (n=50) U.S. (n=88)
Discectomy 60 52.2
Fusion 10 14.8
Decompression 12 8.0
Discectomy & decompression 4 9.1
Discectomy & fusion 10 11.4
Decompression & fusion 2 2.3
Discectomy/decompression/fusion 2 2.3
reflects number of operations not number of surgeons, because some surgeons had multiple operations


65% of those having a spinal fusion operation had returned to their practice within 4 weeks of the operation, compared with 77% of those undergoing a decompression operation.

The surgeons who underwent a spinal fusion took longer to return to performing operations than those who had a spinal decompression operation.42% were back performing surgery within 4 weeks, compared to 65% of those having a decompression operation.
Conclusions:
Spine surgeons who responded to the questionnaire had an unexpectedly high rate of spine surgery (17%). As spine surgeons are continually witnessing surgical procedure, they may be more likely to accept surgery as a treatment for a back complaint. This same effect can explain the tendency of masseurs to have massage as a treatment, and of claims managers to have higher claim rates than the rest of the population.

The surgeons had unusually short periods of time off work before the operation, brief rehabilitation and rapid return to work after surgery. This may indicate that confidence gained through a thorough knowledge of the spine, the disease, and the treatment reduces apprehension about surgery, facilitates rehabilitation, and decreased disability.

Alternatively motivation associated with self employment may explain the rapid rates of return to work for spine surgeons. The surgeons also had a high level of confidence in their ability to control their work activities. It is also true that the ‘cultural norms of the surgical profession' demand that the surgeon be back at work in a very short time.
References:
PubMed Abstract
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