Department of Orthopaedic Surgery, Division of Spine Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, New York, NY.
Department of Neurological Surgery, University of Virginia Health Systems, Charlottesville, VA.
Spine (Phila Pa 1976). 2018 Oct 15;43(20):1411-1417. doi: 10.1097/BRS.0000000000002625.
A cross-sectional study.
The goal of this study is to investigate how surgeons differ in collar and narcotic use, as well as return to driving recommendations following cervical spine surgeries and the associated medico-legal ramifications of these conditions.
Restoration of quality of life is one of the main goals of cervical spine surgery. Patients frequently inquire when they may safely resume driving after cervical spine surgery. There is no consensus regarding postoperative driving restrictions. This study addresses how surgeons differ in their recommendations concerning cervical immobilization, narcotic analgesia, and suggested timeline of return to driving following cervical spine surgery.
Surgeons at the Cervical Spine Research Society annual meeting completed anonymous surveys assessing postoperative patient management following fusion and nonfusion cervical spine surgeries.
Seventy percent of surgeons returned completed surveys (n = 71). About 80.3% were orthopedic surgeons and 94.2% completed a spine fellowship. Experienced surgeons (>15 years in practice) were more likely to let patients return to driving within 2 weeks than less experienced surgeons (47.1% vs. 24.3%, P = 0.013) for multilevel anterior discectomy and fusion (ACDF) and laminectomy with fusion procedures. There were no differences between surgeons practicing inside and outside the USA for prescribing collars or return to driving time. Cervical collars were used more for fusions than nonfusions (57.7% vs. 31.0%, P = 0.001). Surgeons reported 75.3% of patients ask when they may resume driving. For cervical fusions, 31.4% of surgeons allowed their patients to resume driving while restricting them with collars for longer durations. Furthermore, 27.5% of surgeons allowed their patients to resume driving while taking narcotics postoperatively.
This survey-based study highlights the lack of consensus regarding patient "fitness to drive" following cervical spine surgery. The importance of establishing evidence-based guidelines is critical, as recommendations for driving in the postoperative period may have significant medical, legal, and financial implications.
一项横断面研究。
本研究旨在探讨不同外科医生在颈脊柱手术后颈托和麻醉药物使用以及驾驶建议方面的差异，以及这些情况的相关医疗法律后果。
恢复生活质量是颈脊柱手术的主要目标之一。患者经常询问颈脊柱手术后何时可以安全地恢复驾驶。对于术后驾驶限制，尚未达成共识。本研究探讨了外科医生在颈椎融合和非融合手术后患者管理方面在颈椎固定、麻醉镇痛和建议的驾驶恢复时间表方面的差异。
参加颈椎研究学会年会的外科医生完成了评估颈椎融合和非融合手术后患者管理的匿名调查。
70%的外科医生返回了完整的调查问卷（n=71）。约 80.3%是骨科医生，94.2%完成了脊柱专科培训。经验丰富的外科医生（从业超过 15 年）比经验较少的外科医生更有可能让患者在 2 周内恢复驾驶（47.1%比 24.3%，P=0.013），适用于多节段前路椎间盘切除融合术（ACDF）和椎板切除术融合术。美国内外的外科医生在佩戴颈托或恢复驾驶时间方面没有差异。颈托在融合术中比非融合术中更常用（57.7%比 31.0%，P=0.001）。外科医生报告 75.3%的患者询问何时可以恢复驾驶。对于颈椎融合术，31.4%的外科医生允许患者在限制佩戴颈托更长时间的情况下恢复驾驶。此外，27.5%的外科医生允许患者在术后服用麻醉药物时恢复驾驶。
基于调查的研究强调了在颈脊柱手术后，关于患者“适合驾驶”的共识缺乏。建立循证指南至关重要，因为术后驾驶建议可能具有重大的医疗、法律和财务影响。
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