Return to Work After Anterior Cervical Disc Replacement vs. Fusion

Study Design. Systematic review and meta-analysis. Objective. To compare return-to-work (RTW) outcomes between anterior cervical discectomy and fusion (ACDF) and anterior cervical disc replacement (CDR) in working-aged patients with degenerative cervical spine disease. Summary of Background. Degenerative cervical spine disease frequently affects individuals in their prime working years, causing physical and economic burden. 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. Methods. 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 6 weeks, 3 months, 6 months, 1 year, 2 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. Results. Sixteen studies comprising 5,657 patients (2,650 ACDF, 3,007 CDR) and a total of 9,202 RTW outcomes recorded (4,024 ACDF, 5,178 CDR) were included in the study. CDR patients had significantly higher odds of RTW at 6 weeks (OR=1.33, P =0.01), 3 months (OR=1.58, P =0.001), and 1 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 2 years (OR=1.12, P =0.18) or beyond 2 years (OR=1.28, P =0.20). Conclusion. CDR facilitates earlier RTW compared to 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 of Evidence. Level I.