Perez-Albela Alejandro, Nassar Joseph E, Thomson Cameron, Shah Ishan, Diebo Bassel G, Daniels Alan H, Basques Bryce A
Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI.
Spine (Phila Pa 1976). 2025 Aug 15;50(16):1110-1119. doi: 10.1097/BRS.0000000000005319. Epub 2025 Feb 28.
Systematic review and meta-analysis.
To compare return-to-work (RTW) outcomes between anterior cervical discectomy and fusion (ACDF) and anterior cervical disk replacement (CDR) in working-aged patients with degenerative cervical spine disease.
Degenerative cervical spine disease frequently affects individuals in their prime working years, causing physical and economic burdens. While both ACDF and CDR are effective surgical options, CDR may allow for faster recovery and earlier RTW. However, prior studies have reported inconsistent findings on RTW outcomes.
Medline, PubMed, Cochrane, and Google Scholar (pages 1-20) were searched from January 2000 through October 15, 2024, in accordance with the PRISMA guidelines. Data regarding RTW by six weeks, three months, six months, one year, two years, 2+ years, and mean days to RTW were extracted. Study demographics, including levels operated on, BMI, age, and gender, were also collected. Odds ratios (OR) and mean differences were calculated for RTW.
Sixteen studies comprising 5657 patients (2650 ACDF, 3007 CDR) and a total of 9202 RTW outcomes recorded (4024 ACDF, 5178 CDR) were included in the study. CDR patients had significantly higher odds of RTW at six weeks (OR=1.33, P =0.01), three months (OR=1.58, P =0.001), and one year (OR=1.35, P =0.04). CDR also led to an earlier RTW by an average of 9.91 days [95% CI (2.01, 17.81), P =0.01]. No significant differences were observed at two years (OR=1.12, P =0.18) or beyond two years (OR=1.28, P =0.20).
CDR facilitates earlier RTW compared with ACDF within the first postoperative year, reflecting the benefits of its motion-preserving design and reduced fusion-related recovery restrictions. These findings highlight the value of CDR for working-aged individuals, particularly those prioritizing a faster return to professional and social activities.
Level I.
系统评价与荟萃分析。
比较在患有退行性颈椎病的工作年龄患者中，颈椎前路椎间盘切除融合术（ACDF）和颈椎前路椎间盘置换术（CDR）后的重返工作岗位（RTW）结果。
退行性颈椎病经常影响处于黄金工作年龄段的个体，造成身体和经济负担。虽然ACDF和CDR都是有效的手术选择，但CDR可能使恢复更快且RTW更早。然而，先前的研究报告了关于RTW结果的不一致发现。
根据PRISMA指南，检索了2000年1月至2024年10月15日期间的Medline、PubMed、Cochrane和谷歌学术（第1 - 20页）。提取了六周、三个月、六个月、一年、两年、两年以上以及RTW平均天数的RTW数据。还收集了研究的人口统计学数据，包括手术节段、体重指数、年龄和性别。计算RTW的比值比（OR）和平均差异。
该研究纳入了16项研究，共5657例患者（2650例行ACDF，3007例行CDR），记录了总共9202个RTW结果（4024个ACDF，5178个CDR）。CDR患者在六周（OR = 1.33，P = 0.01）、三个月（OR = 1.58，P = 0.001）和一年（OR = 1.35，P = 0.04）时RTW的几率显著更高。CDR还使RTW平均提前9.91天[95%置信区间（2.01，17.81），P = 0.01]。在两年时（OR = 1.12，P = 0.18）或两年以上时（OR = 1.28，P = 0.20）未观察到显著差异。
与ACDF相比，CDR在术后第一年内促进更早的RTW，这反映了其保留运动设计的益处以及减少了与融合相关的恢复限制。这些发现突出了CDR对工作年龄个体的价值，特别是那些优先考虑更快重返职业和社交活动的个体。
I级。
