Driving abstinence is necessary after lumbar spinal fusion: a prospective cohort study

Abstract

Purpose Studies on driving safety after lumbar spinal procedures are rare. Previous studies solely reported on a) driving reaction time (DRT) after lumbar nerve root blocks, b) DRT after discectomy and c) preliminary DRT findings after lumbar fusion. Methods DRT was assessed with a driving simulator as described before. Measurements were done one day before surgery (preop DRT), one week after surgery (postop1 DRT), three months (postop2 DRT) and one year postoperatively (postop3 DRT). Back pain was determined with visual analogue scales (VAS) on all four occasions. Additionally, we monitored each patient's pre-operative driving frequency and intake of analgesics. For statistical analysis we used an ANOVA for repeated measurements. Results Thirt eight of 51 patients completed all measurements (17 monosegmental fusion, 14 polysegmental fusion, seven other lumbar fusion procedures). The longitudinal changes in DRT showed overall significance (p = 0.013). Post-hoc tests determined p = 0.035 for the DRT-increase from pre-to postoperative. We did not determine a significant statistical effect for the type of surgery (p = 0.581) or patient age (p = 0.134). A tendency towards statistical significance was ascertained for the influence of patients' driving frequency on DRT (p = 0.051). Conclusions We found increased DRT at the time of discharge after lumbar spinal fusion and therefore recommend driving abstinence for the time thereafter. Based on our findings it appears safe to return to driving at 3 months postoperative.

Driving Safety after Spinal Surgery: A Systematic Review

“…One article was excluded because it was published in two different journals [8]. Consequently, six studies met our inclusion criteria and were included in this review (Table 1) [236789]. Among these studies, three studies had reviewed the changes in DRT after lumbar spinal intervention, after cervical spinal surgery in one study, and after cervical or lumbar spinal surgery in one study.…”

“…Among these studies, three studies had reviewed the changes in DRT after lumbar spinal intervention, after cervical spinal surgery in one study, and after cervical or lumbar spinal surgery in one study. The range of procedures reviewed included selective nerve root block [2], anterior cervical discectomy and fusion (ACDF) [6], lumbar fusion and/or decompression [379], and posterior sequestrectomy or subtotal discectomy [12]. …”

“…In 2016, Liebensteiner et al [7] repeated the study with a greater and more homogeneous sample size. The authors extended their previous study to include 38 patients, which were subdivided into subgroups based on the number of lumbar levels fused.…”

“…Of note, the patients were not tested between the time of discharge (1 week) and the postoperative follow-up visit at 3 months. Since Liebensteiner et al [7] noted no significant difference between the pre and postoperative DRT after the various types of lumbar fusion interventions, their recommendations might be valid for the majority of types of lumbar fusion.…”

“…The apparatus used to determine preoperative and postoperative DRT in five of the six reviewed studies was a custom-made in-office driving simulator test that measured drivers' perceptions and reaction times [23678]. The stimulator allowed users to stimulate normal driving habits with an adjustable car seat fixed on a frame with hanging pedals.…”