Return to duty rates in active-duty military: Comparing minimally invasive and open cervical spine surgery

Abstract: BACKGROUND: Military medical readiness plays a significant role in global military operations. While the severity of combat-related trauma is evident, musculoskeletal injuries (MSK's), are the largest medical threat to deployment readiness, and accounted for more than 60% of limited duty days in 2019. Across MSK's, the spine (lumbosacral: 30%; cervical: 22%; thoracic: 10%) accounts for 62% of MSKs. In the military population, there is a tremendous economic impact in training, retaining, and deploying a service member. Return-to-duty (RTD) rates and length of time for the treatment protocols for spine surgery vary significantly in published research. Research suggests RTD rates between 3-17 months following elective traditional open lumbar and cervical spine surgery, with a RTD rate of 64% within 1 year. When examining minimally invasive lumbar spine surgery (MIS), 100% of military personal had a RTD within 3 months. Research has yet to examine the impact of MIS of the cervical spine on the RTD rates of active-duty military. METHODS: The current study retrospectively examined surgical outcomes, return to duty, and patient-centric outcomes among 156 active duty or reserve military patients who underwent an outpatient minimally invasive (n = 79) cervical spine surgery or an open (n = 77) (Laminotomy/Foraminotomy/Decompression) for the treatment of cervical spinal stenosis. RESULTS: Significant reductions in visual analog scale of 3.31 and neck disability index of 16.01 were observed from preoperative to postoperative time points. 77% of service members RTD in less than 1 month, 19% RTD in 1-2 months and 4% RTD between 2-3 months. There were insignificant differences reported in the open surgery group. DISCUSSIONS: MIS has been shown to reduce tissue trauma and patient complications. MIS procedures have resulted in reducing postoperative stress responses and improving the recovery process following surgery. In the active-duty military population this plays an important role in return to duty quickness. Our findings suggest that MIS procedures in an ambulatory surgery center on the cervical spine result in improved patient outcomes and reduced RTD time in active-duty military personnel.