Return to work rates and activity profiles: are there differences between those receiving C-ADR and ACDF?

ABSTRACT

Study design: Comparative effectiveness review.

Study rationale: The ability of a patient to return to work and the speed with which this occurs are important outcome metrics for the assessment of patients undergoing spinal surgery.

Clinical questions: In patients with degenerative disease of the cervical spine, does cervical artificial disc replacement (C-ADR) lead to better work-related outcomes than fusion? Does return to work after surgery differ based on gender, age, smoking, litigation status, workers’ compensation status, or other sociodemographic factors?

Methods: A systematic search and review of the English-language literature was undertaken to identify studies published through October 2, 2011. PubMed, Cochrane, National Guideline Clearinghouse Databases, and bibliographies of key articles were searched. Two individuals independently reviewed articles based on inclusion and exclusion criteria, which were set a priori. Each article was evaluated using a predefined quality-rating scheme.

Results: For follow-up periods of more than 6 months, there was no significant difference in work status between disc replacement and fusion patients; however, C-ADR patients began working sooner after surgery. Statistical significance for earlier return was not reached in all studies.

Conclusions: Most patients undergoing cervical decompression and fusion or C-ADR return to work. The rates are equivalent at 6 months but patients treated with C-ADR resumed work sooner.

• REFERENCES

• 1 Heller JG, Sasso RC, Papadopoulos SM et al. 2009; Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34 (2) 101-107
• 2 Sasso RC, Anderson PA, Riew KD et al. 2011; Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am 93 (18) 1684-1692
• 3 Cheng L, Nie L, Li M et al. 2011; Superiority of the Bryan®) disc prosthesis for cervical myelopathy: a randomized study with 3-year followup. Clin Orthop Relat Res 469 (12) 3408-3414
• 4 Burkus JK, Haid RW, Traynelis VC et al. 2010; Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine 13 (3) 308-318
• 5 Mummaneni PV, Burkus JK, Haid RW et al. 2007; Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6 (3) 198-209
• 6 Murrey D, Janssen M, Delamarter R et al. 2009; Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9 (4) 275-286
• 7 Coric D, Cassis J, Carew JD et al. 2010; Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up: clinical article. J Neurosurg Spine 13 (6) 715-721
• 8 Steinmetz MP, Patel R, Traynelis V et al. 2008; Cervical disc arthroplasty compared with fusion in a workers’ compensation population. Neurosurgery 63 (4) 741-747