20
PATIENT OUTCOMES
From the Hospital for Special Surgery in New York, New York.
Return to Activity Following Cervical Disc Arthroplasty Chad Z. Simon, BS
Cer v ica l spondylosis is pr imarily t reated w it h t he gold standard anterior cervical discectomy and fusion (ACDF),1-3 Eric Mai, BS but over the past decade, cervical disc arthroplast y (CDA) has ga ined popu la r it y as a n anterior alternative.4 CDA can achieve symptomatic relief for 1- to 2-level mild-to-moderate Cole Kwas, BA degeneration while maintaining disc height, preserving motion, and reducing adjacent segment loading.5-6 Importantly, CDA has demonstrated similar or earlier unrestricted return to activities Tomoyuki Asada, MD (RTA) in the early postoperative period compared to ACDF, but the current body of evidence is still in its early stages.7 Young, ac t ive pat ient s wou ld l i kely desire and benefit from earlier Sheeraz A. Qureshi, MD, MBA RTA a nd t he reta i ned ra nge of motion (ROM),4,8 and spine surgeons should endeavor to elucidate the RTA timeline when recommending CDA. In the present article, we aim to clarif y RTA as it relates to work, sports, and multi-level constructs in order to assist t he spine surgeon in properly counseling art hroplast y candidates on postoperative outcomes.
Fall 2023
Vertebral Columns
Return to Work As CDA continues to grow in its clinical applicability, most cases are being performed in patients from 40-54 years old. 9 Many patients within this age demographic find themselves in the middle of their working careers. As such, the ability to return to work (RTW) represents a critical indicator of surgical success for both patients and surgeons alike. Several randomized controlled trials have characterized RTW timelines for CDA and ACDF. Heller et al found significantly different median RTW intervals of 48 and 61 days for CDA with BRYAN Cervical Discs (Medtronic, Minneapolis, MN) and ACDF groups, respectively.10 Similarly, Cheng et al found that patients undergoing CDA with the BRYAN implant returned to work sooner after surgery compared to the ACDF group (20 vs 84 days).11 Mummaneni et al compared outcomes between CDA with the PRESTIGE Cervical Disc System (Medtronic, Minneapolis MN) and ACDF and found that patients in the CDA group returned to work 16 days sooner than those in the ACDF group (45 vs 61 days), but this finding was not statistically significant.12 The authors of these 3 studies suggested this difference may be due to better functional and neurological outcomes, retained preoperative ROM, and fewer adverse events in the early postoperative period. Differences in RTW for all
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