Clin Spine Surg. 2023 Jan 23. doi: 10.1097/BSD.0000000000001430. Online ahead of print.
STUDY DESIGN: Prospective Cohort Study.
OBJECTIVES: This study aims to determine the timing and clinical parameters for a safe return to driving.
SUMMARY OF BACKGROUND DATE: Returning to driving after cervical spine surgery remains a controversial topic, with no clear consensus on how to best assess a patient’s fitness to drive. Previous studies using brake reaction time or subjective questionnaires recommend a return to driving 6 weeks after surgery.
METHODS: Patients above 18 years of age who underwent anterior cervical spine surgery for symptomatic cervical degenerative disk disease and possessed a valid motorcar driving license were recruited from 2018 to 2020. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, range of motion, and functional strength of the cervical spine were collected preoperatively and at 2-, 4-, 6- and 12 weeks postsurgery. Patients underwent a standard functional driving assessment protocol at the institution to determine their fitness to drive. This comprised of a clinic-based off-road screening tests and on-road driving test in a real-world environment.
RESULTS: Twenty-one patients were recruited. The mean age was 56.6±8.9 years. Eighty-one percent of the patients passed the on-road driving assessment at 6 weeks. Patients who passed the driving assessment had lower mean NDI scores, 3.4±3.1 versus 10.8±8.0 (P=0.006), and higher mean mJOA scores 16.1±0.6 versus 15.0±1.8 (P=0.045). Patients who passed the driving assessment also had higher functional cervical flexor strength, 21.1s±5.8s versus 13.0s±10.2s (P=0.042) in a supine position but not correlated with a range of motion of the spine in all directions.
CONCLUSION: Most patients undergoing single or dual-level anterior cervical surgery for symptomatic cervical degenerative disk disease demonstrate the ability to pass a standardized driving assessment and are safe to return to driving more than 6 weeks after surgery. Driving ability appears to be correlated with NDI scores ≤3 (P=0.006), mJOA scores ≥16 (P=0.045), and cervical flexion endurance of ≥21s (P=0.042).
LEVEL OF EVIDENCE: Level II.
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