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.
