A Comparative Analysis of Return to Driving Ability after Elective Anterior Cervical Discectomy and Fusion Amongst Patients with Myelopathy versus Radiculopathy.

Abstract

Retrospective cohort study. To investigate the influence of preoperative myelopathy versus radiculopathy on timing of return to driving following anterior cervical discectomy and fusion (ACDF). ACDF is among the most common spinal procedures performed; however, a gap exists in the literature concerning postoperative recovery timelines. Adults who underwent elective ACDF (2014-2022) were identified. Patients without Neck Disability Index (NDI) scores and those who underwent ACDF for tumor/trauma/infection were excluded. Demographic/surgical variables, preoperative diagnosis, and duration of symptoms were collected. NDI driving status was assessed preoperatively, and postoperatively (<1/1-3/3-6/6-12, and 12-24 mo). Driving component score of 0-2 was considered able to drive, whereas scores 3-5 were considered unable. 975 patients (532 with myelopathy) were included. Myelopathic patients were older (59.1 vs. 53.4, P<0.001) and had higher BMI (30.4 vs. 29.4, P=0.035). They had more levels fused (2.27 vs. 1.90, P<0.001) and longer LOS (1.77 vs. 1.32 d, P<0.001). Although myelopathic patients had better driving scores preoperatively (1.66 vs. 2, P<0.001), they had worse scores at <1 month (3.45 vs. 2.84, P=0.048) and 1-3 months (1.39 vs. 1.03, P=0.019) postoperatively compared to radiculopathy patients. Multivariable regression showed myelopathy diagnosis as independently associated with lower driving score at <1 month (OR: 2.24, P=0.021) and decreased percentage returning to driving at 1-3 months (OR: 0.45, P=0.002) when controlling for age, number of levels fused, and preoperative driving ability. Myelopathic patients had predictable demographic and surgical differences compared to radiculopathic patients, including increased age and more levels fused. Despite superior preoperative NDI driving scores, multivariable regression identified myelopathy as independently associated with worse postoperative scores at <1month and lower percentage of patients returning to driving at 1-3 months. Surgeons should be cautious regarding early lifting of driving restrictions for myelopathic patients undergoing ACDF. III.