Driving Safety after Spinal Surgery: A Systematic Review

Abstract

This study aimed to assess driving reaction times (DRTs) after spinal surgery to establish a timeframe for safe resumption of driving by the patient postoperatively. The MEDLINE and Google Scholar databases were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement for clinical studies that investigated changes in DRTs following cervical and lumbar spinal surgery. Changes in DRTs and patients' clinical presentation, pathology, anatomical level affected, number of spinal levels involved, type of intervention, pain level, and driving skills were assessed. The literature search identified 12 studies that investigated postoperative DRTs. Six studies met the inclusion criteria; five studies assessed changes in DRT after lumbar spine surgery and two studies after cervical spina surgery. The spinal procedures were selective nerve root block, anterior cervical discectomy and fusion, and lumbar fusion and/ordecompression. DRTs exhibited variable responses to spinal surgery and depended on the patients' clinical presentation, spinal level involved, and type of procedure performed. The evidence regarding the patients' ability to resume safe driving after spinal surgery is scarce. Normalization of DRT or a return of DRT to pre-spinal intervention level is a widely accepted indicator for safe driving, with variable levels of statistical significance owing to multiple confounding factors. Considerations of the type of spinal intervention, pain level, opioid consumption, and cognitive function should be factored in the assessment of a patient's ability to safely resume driving.

Break Reaction Time after Conservatively Treated Ligament Ruptures of the Ankle

“…Compared to the healthy controls' BRT (535.6 ±118.6ms), the patients' BRT was significantly slower at two weeks (p = 0.003) but not different at four weeks (p = 0.473) (Cross-sectional comparison, Hypothesis 2, Table 2 ). At this point in time, the BRT was also well below what was recommended by road authorities (70 0-150 0ms) [17][18][19][20][21] . Notwithstanding the genuine slow brakers (n = 4, 13,3%), who never successfully achieved sufficient BRTs, all patients (n = 13 out of n = 13) with an AOFAS-AHS score of more than 80 points had sufficient BRTs within two weeks (100%) (Hypothesis 3).…”

Return to Driving Is Safe 6 Weeks After Anterior Cervical Surgery for Symptomatic Cervical Degenerative Disc Disease

“…Most (n=13, 61.9%) patients who passed the DARP did so at the 6-week mark, which corresponded to statistically significant improvements in NDI, mJOA scores, and functional strength of the cervical spine flexors. Previous studies utilizing BRT have demonstrated nonstatistically significant increases1,3,8 or reductions2 in BRT after cervical spinal surgery and recommend a return to driving after discharge from the hospital. Most authors1,8,41,42 do, however, caution against the use of BRT exclusively for determining the driving ability and recommend evaluating the patient holistically due to the complex nature of driving as well as the medicolegal ramifications of certifying a patient for driving when they are not clinically ready.…”

“…Previous studies utilizing BRT have demonstrated nonstatistically significant increases1,3,8 or reductions2 in BRT after cervical spinal surgery and recommend a return to driving after discharge from the hospital. Most authors1,8,41,42 do, however, caution against the use of BRT exclusively for determining the driving ability and recommend evaluating the patient holistically due to the complex nature of driving as well as the medicolegal ramifications of certifying a patient for driving when they are not clinically ready. Kelly et al,27 utilizing the driving subsection of the NDI, reported that 49.6% of patients reported moderate to severe difficulty in driving preoperatively, with the majority of patients demonstrating little to no driving difficulty at 6 weeks postoperation.…”

“…[4][5][6][7] In addition, professional drivers with SCDDD may be reluctant to undergo surgery as their livelihoods and incomes may be affected. While some studies have shown that patients may be fit to return to driving upon discharge from the hospital after surgery, 8 an earlier return to driving before patients have recovered fully may result in catastrophic accidents and present a public safety hazard. The lack of consensus among the surgical community regarding timing and appropriate qualifying criteria for returning to driving further provides a significant stumbling block for providing recommendations to a majority of patients (75.4%) who worry about driving after surgery.…”