Department of Orthopaedic Surgery, Woodlands Health.
Department of Occupational Therapy, Tan Tock Seng Hospital.
Clin Spine Surg. 2023 Jun 1;36(5):E218-E225. doi: 10.1097/BSD.0000000000001430. Epub 2023 Jan 23.
Prospective Cohort Study.
This study aims to determine the timing and clinical parameters for a safe return to driving.
Returning to driving after cervical spine surgery remains a controversial topic, with no clear consensus on how to best assess a patient's fitness to drive. Previous studies using brake reaction time or subjective questionnaires recommend a return to driving 6 weeks after surgery.
Patients above 18 years of age who underwent anterior cervical spine surgery for symptomatic cervical degenerative disk disease and possessed a valid motorcar driving license were recruited from 2018 to 2020. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, range of motion, and functional strength of the cervical spine were collected preoperatively and at 2-, 4-, 6- and 12 weeks postsurgery. Patients underwent a standard functional driving assessment protocol at the institution to determine their fitness to drive. This comprised of a clinic-based off-road screening tests and on-road driving test in a real-world environment.
Twenty-one patients were recruited. The mean age was 56.6±8.9 years. Eighty-one percent of the patients passed the on-road driving assessment at 6 weeks. Patients who passed the driving assessment had lower mean NDI scores, 3.4±3.1 versus 10.8±8.0 ( P =0.006), and higher mean mJOA scores 16.1±0.6 versus 15.0±1.8 ( P =0.045). Patients who passed the driving assessment also had higher functional cervical flexor strength, 21.1s±5.8s versus 13.0s±10.2s ( P =0.042) in a supine position but not correlated with a range of motion of the spine in all directions.
Most patients undergoing single or dual-level anterior cervical surgery for symptomatic cervical degenerative disk disease demonstrate the ability to pass a standardized driving assessment and are safe to return to driving more than 6 weeks after surgery. Driving ability appears to be correlated with NDI scores ≤3 ( P =0.006), mJOA scores ≥16 ( P =0.045), and cervical flexion endurance of ≥21s ( P =0.042).
Level II.
前瞻性队列研究。
本研究旨在确定安全驾驶返回的时间和临床参数。
颈椎手术后恢复驾驶仍然是一个有争议的话题，对于如何最好地评估患者的驾驶能力尚无明确共识。先前使用制动反应时间或主观问卷的研究建议术后 6 周恢复驾驶。
2018 年至 2020 年，招募了因症状性颈椎退行性椎间盘疾病而行前路颈椎手术且拥有有效汽车驾驶执照的年龄在 18 岁以上的患者。在术前和术后 2、4、6 和 12 周收集颈痛残疾指数（NDI）、改良日本骨科协会（mJOA）评分、颈椎活动度和功能强度。患者在机构接受标准的功能驾驶评估方案，以确定其驾驶能力。这包括基于诊所的越野筛查测试和在现实环境中的道路驾驶测试。
共招募了 21 名患者。平均年龄为 56.6±8.9 岁。81%的患者在 6 周时通过了道路驾驶评估。通过驾驶评估的患者的平均 NDI 评分较低，分别为 3.4±3.1 与 10.8±8.0（P=0.006），mJOA 评分较高，分别为 16.1±0.6 与 15.0±1.8（P=0.045）。通过驾驶评估的患者还具有更高的颈椎屈肌功能强度，仰卧位时分别为 21.1s±5.8s 和 13.0s±10.2s（P=0.042），但与脊柱各方向的活动度无相关性。
大多数因症状性颈椎退行性椎间盘疾病而行单节段或双节段前路颈椎手术的患者能够通过标准化驾驶评估，并且在术后 6 周以上安全返回驾驶。驾驶能力似乎与 NDI 评分≤3（P=0.006）、mJOA 评分≥16（P=0.045）和≥21s 的颈椎前屈耐力（P=0.042）相关。
2 级。
