Neurosurgeon Neurosurgery & Spine Group / Cedars Sinai Medical Center West Hills, CA, US
Disclosure(s):
Jared D. Ament, MD, MPH, FAANS, FACS: No financial relationships to disclose
Introduction: Artificial disc replacement (ADR) has become an evidence-based alternative to traditional fusion surgery. Current guidelines for safe return-to-activity levels following surgery have yet to be determined. This Modified Delphi study aimed to establish expert-sourced consensus for safe and optimized return-to-activity recommendations following cervical disc arthroplasty.
Methods: Eleven expert spine surgeons with an average of fifteen years of surgical experience participated in a three-round Modified Delphi Method. The first round presented experts with eleven clinical cases and nineteen multiple-choice questions regarding recommendations for patient return to activity following surgery for one-, two-, or three-level arthroplasty. First-round responses were analyzed and presented in second-round surveys to the experts, who repeated nineteen multiple-choice questions. The third round presented consensus recommendation statements derived from the second round for the final assessment of the expert agreement.
Results: Experts agreed on nineteen of twenty-two (86.4%) post-arthroplasty return-to-activity recommendations. Eight recommendations achieved unanimous agreement, the most robust consensus (95% - 100% agreement) including recommendations that patients may return to basic activities such as walking, social activities, sedentary work, air travel, and sexual activity within two weeks of arthroplasty surgery; and arthroplasty patients will have a shorter recovery, resuming normal activities sooner than fusion patients. Experts agree that patients may return to light and heavy physical activity (strong consensus) earlier for 2- and 3-level ADR compared to hybrid constructs (a combination of ADR and fusion surgeries). Experts agreed that ADR patients can resume light physical activity at 4-6 weeks and engage in intense conditioning and sport-specific training at six weeks. However, a weaker consensus was achieved for returning to physically demanding work at 4-6 weeks and high-intensity physical activity/sports at six weeks, indicating that individual patient factors and the specific nature of the activity should be considered.
Conclusion : This study provides the first consensus-based recommendations for returning to activity following cervical disc arthroplasty. These expert-derived guidelines empower patients and healthcare professionals to make informed decisions about returning to activity after surgery.