Cervical disc arthroplasty compared with fusion in a workers' compensation population.
OBJECTIVE
Patients with cervical radiculopathy and/or myelopathy are often treated with anterior cervical discectomy and fusion. Cervical arthroplasty has recently been advocated as an alternative treatment. Theoretically, arthroplasty should permit early return to activity and protect against adjacent segment disease. Early mobilization and return to activity may, theoretically, reduce cost to the workers' compensation program.


METHODS
A subgroup analysis of workers' compensation patients from the randomized controlled trials comparing Prestige ST and Bryan (Medtronic Sofamor Danek, Memphis, TN) cervical arthroplasty to fusion was performed. Primary outcome measures were work status, time to return to work, and neck disability. Secondary outcome measures were neck and arm pain and Medical Outcomes Study Short-Form 36-Item Health Survey score.


RESULTS
One thousand four patients were enrolled in the studies, 93 of whom were workers' compensation patients. At 6 weeks and 3 months, significantly more patients in the arthroplasty group were working compared with the fusion group. At 6 months and later, there was no significant difference in return-to-work rates. Overall, patients returned to work at a median of 101 days after arthroplasty, compared with 222 days after anterior cervical discectomy and fusion. This difference was not significant when controlling for sex, study, and preoperative work status. At all time points, the Neck Disability Index was consistently lower in the arthroplasty group compared with the fusion group; however, the difference was not significant at 24 months. There was no statistically significant difference in secondary outcomes, neurological events, or pain-related events.


CONCLUSIONS
In this workers' compensation cohort, it was observed that a greater number of patients in the arthroplasty group returned to work at 6 weeks and 3 months after surgery. A trend toward an earlier return to work was also seen, although this was not statistically significant when controlling for differences in the studies.
Steinmetz
Michael P
MP
Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. steinmm@ccf.org
Patel
Rakesh
R
Traynelis
Vincent
V
Resnick
Daniel K
DK
Anderson
Paul A
PA
D000328:Adult; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D003289:Convalescence; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D004434:Early Ambulation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009989:Orthotic Devices; D017063:Outcome Assessment, Health Care; D019736:Prostheses and Implants; D011843:Radiculopathy / Q000473:pathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020127:Recovery of Function; D013118:Spinal Cord Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D014481:United States; D014942:Workers' Compensation / Q000706:statistics & numerical data