Department of Neurological Surgery, MD Anderson Cancer Center, Houston, Texas, USA.
Department of Neurological Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA.
World Neurosurg. 2022 Jun;162:e309-e318. doi: 10.1016/j.wneu.2022.03.004. Epub 2022 Mar 5.
Given the paucity of relevant data, the Council of State Neurosurgical Societies Workforce Committee launched a survey of neurosurgeons to assess patterns in activity restriction recommendations following spine surgery; the ultimate goal was to optimize and potentially standardize these recommendations. The aim of this initial study was to determine current practices in activity restrictions and return to work guidelines following common spinal procedures.
The survey included questions regarding general demographics and practice data, postoperative bracing/orthosis utilization, and guidelines for postoperative return to different levels of activity/types of work following specific spine surgery interventions. A spectrum of typical spine surgeries was assessed, including microdiscectomy, anterior cervical discectomy and fusion (ACDF), and lumbar fusion, both open and minimal invasive surgery (MIS) approaches.
There was significant interprocedure and intraprocedure variation in the neurosurgeons' recommendations for postoperative activity and return to work recommendations after various spinal surgery procedures. Comparisons of the different surgical procedures evaluated revealed significant differences in cervical collar use (more often used following ≥2-level ACDF than single-level ACDF; P < 0.001), return to both sedentary and light physical work (greater restriction with ≥2-level ACDF than with single-level ACDF; P < 0.001), and return to a light exercise regimen (sooner following MIS versus open lumbar fusion; P < 0.001).
This survey demonstrated little consistency regarding return to work recommendations, general activity restrictions, and orthosis utilization following common spinal surgical procedures. Addressing this issue also has significant implications for the societal and personal costs of spine surgery.
鉴于相关数据的匮乏，州立神经外科学会劳动力委员会启动了一项针对神经外科医生的调查，以评估脊柱手术后活动限制建议的模式；最终目标是优化并可能标准化这些建议。本研究的目的是确定常见脊柱手术后活动限制和恢复工作指南的当前实践。
该调查包括有关一般人口统计学和实践数据、术后支具/矫形器使用以及特定脊柱手术干预后不同水平活动/工作类型的术后恢复指南的问题。评估了一系列典型的脊柱手术，包括微创椎间盘切除术、前路颈椎间盘切除术和融合术（ACDF）以及腰椎融合术，包括开放和微创手术（MIS）方法。
在各种脊柱手术程序的术后活动和恢复工作建议方面，神经外科医生的建议存在明显的程序间和程序内差异。对评估的不同手术程序的比较显示，颈椎领的使用存在显著差异（≥2 级 ACDF 比单级 ACDF 更常使用；P < 0.001），恢复到久坐和轻度体力工作（≥2 级 ACDF 比单级 ACDF 限制更大；P < 0.001），以及恢复到轻度运动方案（MIS 比开放腰椎融合术更早；P < 0.001）。
这项调查表明，在常见脊柱手术程序后，关于恢复工作建议、一般活动限制和矫形器使用的一致性很小。解决这个问题对于脊柱手术的社会和个人成本也有重要意义。
