Timelines and associated factors for return-to-work of patients with painful lumbar radiculopathy who undergo lumbar microdiscectomy followed by physiotherapy: a prospective cohort study

Study design. Prospective cohort study with a 52 weeks follow-up. Objective. To describe the probability of return to work and explore associations between routinely collected pre-operative factors and return to work for patients with painful lumbar radiculopathy undergoing lumbar microdiscectomy and post-operative physiotherapy. Summary of background data. Medical absenteeism in patients with painful lumbar radiculopathy undergoing lumbar microdiscectomy followed by physiotherapy is associated with high socioeconomic costs. We lack good quality information about the time to return to work and the factors associated with returning to work in this patient group. Methods. We included 257 patients with clinical signs and symptoms of painful lumbar radiculopathy in whom nerve root compression was confirmed by Magnetic Resonance Imaging, and who underwent microdiscectomy and post-operative physiotherapy. Time to return to work was evaluated using Kaplan-Meier survival analysis. The association between independent factors and return to work was examined through Cox regression analysis. Results: Full resumption of their original paid job (i.e., same role with the same physical demands and responsibilities) occurred in 178 (69.3%) of participants by 52 weeks. In these patients, the median (IQR) return to work time was 16 weeks (14–16), with 85.0% of patients resuming work within 26 weeks. Higher education (HR=1.82), self-employment (HR=1.84), and the absence of predominant physical work (HR=1.61) were significantly associated with a faster return to work, while higher disability scores negatively impacted return to work time (HR=0.56). Conclusion: At 52 weeks following lumbar microdiscectomy and post-operative physiotherapy for painful lumbar radiculopathy, approximately two-thirds of individuals returned to work in their original roles, while some transitioned to different roles. Work-related and personal factors play a key role in determining the timing of this return. Recognizing these predictors in clinical practice can help surgeons, physiotherapists, and occupational health professionals guide patient expectations, provide more individualized workplace counselling, and support realistic, timely, and sustainable work reintegration.