Early Indicator of Lumber Spine Surgery after Occupational Back Injury: Finding from a Prospective Study
Abstract
Introduction: Occupational back injuries are a leading cause of disability and work absenteeism worldwide. Early identification of patients at high risk for requiring lumbar spine surgery can facilitate timely intervention and improve clinical outcomes. Objective: To identify early clinical and occupational indicators predictive of lumbar spine surgery within one year following an occupational back injury. Methods: This one-year prospective study at R. G. Kar Medical College & Hospital included 138 patients with occupational back injuries. Data collected covered demographics, job physical demand, delayed return to work, compensation status, and employer support. Clinical evaluations included pain (VAS), neurological deficits, and disability (ODI). MRI was used to identify disc herniation, nerve compression, and spondylolisthesis. Early healthcare use timing of MRI, conservative treatment, and surgeon referral was recorded. Psychosocial factors were assessed with FABQ, PHQ, and PCS questionnaires to identify predictors of lumbar spine surgery within 12 months. Results: Out of 138 patients, 42 (30.4%) had lumbar spine surgery. Surgery patients were older (48.6 vs. 44.3 years, p=0.018), had more heavy physical work (66.7% vs. 41.7%, p=0.008), higher pain scores (VAS 8.1 vs. 6.4, p<0.001), more neurological deficits (64.3% vs. 29.2%, p<0.001), and greater disability (ODI 58.5 vs. 42.3, p<0.001). They had more disc herniation on MRI (76.2% vs. 41.7%, p<0.001), higher psychosocial risk (FABQ 73.8% vs. 39.6%, p<0.001), and were less likely to receive early physiotherapy (28.6% vs. 60.4%, p=0.001). Despite 76.2% achieving ≥30% ODI improvement, fewer returned to full work (42.9% vs. 67.7%, p=0.007). Conclusion: Neurological deficits and MRI-confirmed disc herniation are strong early indicators for lumbar spine surgery in patients with occupational back injuries. Awareness of these predictors can guide clinicians and employers in optimizing management strategies, potentially reducing the need for surgery and improving return-to-work outcomes.Keywords:
Occupational back injury, lumbar spine surgery, early indicators, MRI, neurological deficit, prospective studyReferences
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