Return to Work After Anterior Cervical Disk Replacement Versus Fusion : A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

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.