The document discusses returning to work after spine surgery based on a study of 62 patients in Bangladesh. The majority (79%) of patients who had disc surgery were able to return to their previous professions within 6 weeks. Most patients who had decompression surgery or fixation surgery were also able to return to work, either in the same or a modified profession, within 3-6 months after surgery depending on the procedure. Overall the study found that spine surgery was generally successful in allowing patients to return to work activities with reduced pain and disability.

1. 6TH BSSCON 2015
Returning back to previous work
after spine surgery
Dr. Abu Bakar Siddique
MS (Ortho), WOC-SICOT(UK) Fellow,
Spine microsurgery fellow,
Observer ship on spine deformity correction
(GANGA HOSPITAL,COIMBATORE,INDIA)
Orthopaedic consultant, Chadhanga Sadar
Hospital.

2. 6TH BSSCON 2015
Life is work,
work is life

3. 6TH BSSCON 2015
Returning back to work
is a BLESSINGS
• It is also the most
important outcome
measure of medical
care

4. 6TH BSSCON 2015
It is a success
• Without returning to
work & loving it,
nobody can succeed in
life.

5. 6TH BSSCON 2015
Objectives
• Finding out the answers of
few questions that arise in
patients mind before spine
surgery

6. 6TH BSSCON 2015
Purpose
• To define expectations of
returning to work after
different kinds of spine
surgery.

7. 6TH BSSCON 2015
What eyes say…
• How long will it take to
recover?
• Could I return to work
again?
• How will be my personal &
family life after surgery?

8. 6TH BSSCON 2015
Patients and methods
A total 62
patients are
studied.
Male: 38
Female: 24
Age:37 (18-67)

9. 6TH BSSCON 2015
Methodology
• Study period: 2008-2014
• Follow up period: 29 months (1 to
6 years)
• Surgery performed in different
hospitals of same standard.

10. 6TH BSSCON 2015
Impact Masudul Haque Hospital
Chuadanga

11. 6TH BSSCON 2015
Hitech Multicare & Galaxy
Hospitals

12. 6TH BSSCON 2015
Health & Hope Hospital

13. 6TH BSSCON 2015
Patients selection
criteria
• Working people require spine
surgery
• Retired and non working people
are excluded from this study

14. 6TH BSSCON 2015
Work category
Moderate to heavy worker
• Automobile driver
• Farmer
• Construction worker
• Day laborers
These people having almost same pattern of
works.

15. 6TH BSSCON 2015
Surgery criteria
• Lumber disc surgery: 25
• Recurrent Lumber disc surgery: 3
• Single level decompression: 6
• Double level decompression: 5
• Surgery for Cauda equina syndrome: 5
• Short segment (DL) fixation: 9
• Long segment(DL) fixation: 7
• ACDF: 2

16. 6TH BSSCON 2015
Per Operativs
• Standard peri operative protocol are
followed.
• More emphasize given in post op follow up
Outdoor basis
Home service

17. 6TH BSSCON 2015
Follow up team
• One physiotherapist
• One data collector
• One photographer

18. 6TH BSSCON 2015
Road of recovery
• Rest
• Breathing exercise
• Isometric exercise
• Sitting on bed
• Sitting, standing and kneeling in correct
posture
• Correct working posture-Live/Picture

19. 6TH BSSCON 2015
Case-1
Abdal Hossain 42
• Date juice collector
• Onset – Very acute
• Operation done by 3
weeks
• Before surgery patient
having severe pain
and disability
Oswestry: >60

20. 6TH BSSCON 2015
Follow up
7th Post OP AFTER 30 DAYS
No pain and disability
after 7 days of surgery.
Oswestry <20

21. 6TH BSSCON 2015
Follow up

22. 6TH BSSCON 2015
Follow up
AFTER 12 MONTHS

23. 6TH BSSCON 2015
Returned back to work
Still working in same way

24. 6TH BSSCON 2015
After 4 years

25. 6TH BSSCON 2015
Doing well in profession

26. 6TH BSSCON 2015
PLID L4/L5

27. 6TH BSSCON 2015
Salma-35, Rec plid
3rd POD
House wife, Onset sub
acute, operation done
after 3 month
oswesrty>45

28. 6TH BSSCON 2015
Follow up
After 3 weeks ,pain
reduced, Oswestry<20

29. 6TH BSSCON 2015
Returned back to household
works
AFTER 30 MONTHS OF
RECURRENT PLID
SURGERY

30. 6TH BSSCON 2015
After 5 years

31. 6TH BSSCON 2015
M.A.Majid: 58
• Cauda equina
syndrome
• L3-L4 space involved
• Urologist lapsed 3
weeks time.
• Accidental catheter
injury
• SPC

32. 6TH BSSCON 2015
Preoperative

33. 6TH BSSCON 2015
• Preoperative
Oswestry score was
>56
• After surgery it
improved

34. 6TH BSSCON 2015
After 6 weeks of surgery.
Oswestry came down around 20

35. 6TH BSSCON 2015
After 2 years
No pain & disability

36. 6TH BSSCON 2015
Result
• Passing 6 years of his
surgery.
• Retired school
teacher
• Taking care of his own
rice meal comfortably.

37. 6TH BSSCON 2015
Rubel 27
Farmer, Very acute onset,
surgery done after 4 weeks
Oswestry came down almost 0 from preoperative >50

38. 6TH BSSCON 2015
After 4 years
Got stress on back again

39. 6TH BSSCON 2015
FOLLOW UP
OSWESTRY SCORE >30

40. 6TH BSSCON 2015
Trauma to back
again
• Following a heavy
weight lifting
• Now he is taking
conservative
treatment
• Doing all the house
hold works but with
difficulty

41. 6TH BSSCON 2015
Tito 30,Competent driver,PLID surgery done 5 years
back

42. 6TH BSSCON 2015
After 60 months of
surgery

43. 6TH BSSCON 2015

44. 6TH BSSCON 2015
Abdul Kader 31
AFTER 2 YEAR OF SURGERY
Shopkeeper,
multilevel disc
herniation,
Oswestry
core>45,
Operated earlier

45. 6TH BSSCON 2015
Ibadat Hossain
Spinal stenosis
AFTER 21 DAYS

46. 6TH BSSCON 2015
Betel leaf Farmer
After 3 years

47. 6TH BSSCON 2015
Yunus: 35
Acute on chronic,
Back pain>Leg pain,
Moderate disability,
Oswestry 50
Operation done
after 6 months.

48. 6TH BSSCON 2015
After 30 months

49. 6TH BSSCON 2015
Job modification

50. 6TH BSSCON 2015
Ripon 27,CES
Cauda equina syndrome,
Before surgery
Oswestry>60
After surgery<20
(within 3 weeks of surgery)
Workshop worker cum
electrician

51. 6TH BSSCON 2015
Follow up
Left workshop. Full flagged
busy electrician.
Job modification may open up
a new era in life.

52. 6TH BSSCON 2015

53. 6TH BSSCON 2015
After 2 years

54. 6TH BSSCON 2015
Belal 28 yrs
Construction
worker
Pre op Xray
Pre Op MRI
ASIA- B

55. 6TH BSSCON 2015
Only After 18 months
Started to stand
with supports
Broken the fixation

56. 6TH BSSCON 2015
After 2 years
Bed sores are
operated

57. 6TH BSSCON 2015
After 5 years

58. 6TH BSSCON 2015

59. 6TH BSSCON 2015

60. 6TH BSSCON 2015
Happy couple with 2
children

61. 6TH BSSCON 2015
Long segment
fixation
• Sumon 21
• Compression # L1
• Type B-Denis
• ASIA type-C
• Rx-3 weeks after
trauma

62. 6TH BSSCON 2015
Per operative
Minimum bleeding, One unit of FHB
for long segment fixation.

63. 6TH BSSCON 2015
After 6 weeks

64. 6TH BSSCON 2015
After 3 months
• Comfortable
• No motor weakness.
• Returned back to
work

65. 6TH BSSCON 2015
Rajon 18
College student,
Unstable Compression
# L2 vertebra, ASIA
Type D
C.Fixation done on 10th post
trauma day.Reduction by
destraction,Short segment
fixation & no fusion

66. 6TH BSSCON 2015
After 3 weeks
No Pain,Comfortable.

67. 6TH BSSCON 2015
After 6 weeks
Regain of good spinal curvature.
Returned to profession with brace

68. 6TH BSSCON 2015
After 6 months
Doing well with normal function

69. 6TH BSSCON 2015
Shahid 29 years
ASIA Type C
Com # L2 Vert.
Pre op Xray
Per
operative

70. 6TH BSSCON 2015
After 6 weeks
After 18 months of
surgery

71. 6TH BSSCON 2015
After 18 months ,Good fusion

72. 6TH BSSCON 2015

73. 6TH BSSCON 2015
Transformation of fear into
confidence
AFTER 40 DAYS

74. 6TH BSSCON 2015
Uncertainty into comfort
AFTER 6 WEEK

75. 6TH BSSCON 2015
TRANSFORMATION OF
SORROW INTO SMILE
AFTER 60 DAYS

76. 6TH BSSCON 2015
Results
• By 3-4 weeks most of the patients pain
reduced towards normal.
• Few patients still require pain medication
• Oswestry score reduced around 20 by 3-6
weeks.

77. 6TH BSSCON 2015
Results
• Approximate 90% of patients of those
under went lumber discectomy returned to
work by 6 weeks.
• 80-85 % of patients having short segment
(DL) fixation went back work by12-16
weeks.
• Long segment fixation require little bit
more time to returning works.

78. 6TH BSSCON 2015
• 22 among 28 (79%) patients having disc
surgery, returned to their previous
profession. Most of them are comfortably
doing their duties. Rest 6 (21%) patients
had to change their previous profession. 9
out of 11 patients having decompression
surgeries are doing well with moderate
works in same profession. After cauda
equina surgery, 3 patients are in the same
profession and doing well.

79. 6TH BSSCON 2015
Disc Surgery (28)
Same profession
(22)
Different
profession (6)

80. 6TH BSSCON 2015
Decompression surgery (11)
Sales
Same profession
(9)
Different
profession (2)

81. 6TH BSSCON 2015
Fixation & CES
0
5
10
15
20
25
30
35
40
fixation CES
Total
Different
Same
14
5
3
18
4
2

82. 6TH BSSCON 2015
Observations
• Acuteness of symptoms
• Sub acute presentation –Delayed decision
• CES: Motor recovery happens earlier than
sensory .
• Fixation: In stable TL fracture where
canal compromisation is less than 50%, in
that cases reduction by distraction is
suffice for early recovery.

83. 6TH BSSCON 2015
Observations
• Hardwire failure more occur in long
segment fixation.
• Fusion after surgery happen earlier in
short segment fixation.

84. 6TH BSSCON 2015
Thank You

85. 6TH BSSCON 2015
My Mentor
DR. S. Rajasekaran
Ganga Hospital,
Coimbatore,TN,INDIA

86. 6TH BSSCON 2015
Privilege to work