Return to Work After Isolated Spinal Injury: Rates, Predictors, and Implications for Occupational Reintegration

Spinal injuries are an increasing cause of disability and work absence. While return to work (RTW) is a key outcome, most studies included heterogeneous cohorts with concomitant injuries or spinal cord involvement. This study examined RTW after isolated spinal injury, and identified demographic, clinical, occupational, and socioeconomic predictors of early RTW.

We conducted a retrospective single-center cohort study of patients ≤ 60 years treated for isolated traumatic spinal fractures or discoligamentous injuries (2016-2020). Patients with spinal cord injury, major concomitant trauma, or pathological fractures were excluded. Structured telephone interviews assessed posttreatment, rehabilitation, and occupational outcomes. Early RTW was defined as resumption of employment within six months. Predictors were evaluated using univariate analyses and multivariable logistic regression after least absolute shrinkage and selection operator (LASSO) selection.

In total, 86 patients participated. At 12 months, 71% had returned to work; however, 50% reported workplace limitations and 37% had not regained pre-injury performance. RTW rates varied by treatment and spinal region. In multivariable analysis, surgical treatment (OR 0.13, 95% CI 0.03-0.42), female sex (OR 0.25, 95% CI 0.08-0.72), and working > 30 h/week pre-injury (OR 0.09, 95% CI 0.01-0.66) predicted lower odds of early RTW. Self-employment was positively associated with early RTW in univariate analysis.

Sociocultural, occupational, and medical factors, including female sex, high pre-injury workload, and surgical treatment, significantly influenced RTW outcomes. Future studies should explore tailored rehabilitation and workplace interventions to support at-risk groups and improve long-term reintegration.