Return to work - estimated socioeconomic impact of spontaneous intracranial hypotension and effects of neurosurgical treatment.

Introduction: Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid (CSF) leak is a debilitating but curable condition, often affecting individuals of working age, making a considerably socioeconomic impact likely. Methods: This monocentric retrospective study in Germany analyzed work capacity in patients ≤65 years before and after surgical closure of a spinal CSF leak between April 2018 and September 2024. The economic burden was evaluated via direct hospital costs and indirect costs from productivity losses. Results: Two hundred and ten patients (median age 45.5 years, 62% female), all physically capable of working, were included. After symptom onset, 96% could not perform their professional work as before: 61% were completely unable, 18% reduced working time, and 17% adapted conditions. Three months postoperatively, 55% had completely returned to work, 19% were working part-time. At the last follow-up these numbers further improved to 65 and 17%, respectively, only 9% were still unable to work, 9% had retired. A shorter symptom duration was significantly associated with complete return to work. Median direct costs per patient for diagnosis and treatment was €11,407, indirect costs for 160 days (the median symptom duration before surgery) averaged €21,169. Extrapolated to the incidence rate, the additional annual economic burden in Germany is estimated at €85.75 million for 160 sick days, largely from preventable productivity losses. Conclusion: SIH significantly impairs working ability. Early treatment can restore work capacity and substantially reduces preventable productivity losses, strongly advocating timely intervention not only from a medical but also from an economic perspective.