{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:44:12Z","timestamp":1754487852969,"version":"3.37.3"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"11-12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Among U.S. military active duty service members, cervicalgia, cervical radiculopathy, and myelopathy are common causes of disability, effecting job performance and readiness, often leading to medical separation from the military. Among surgical therapies, anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are options in select cases; however, elective surgeries performed while serving overseas (OCONUS) have not been studied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A retrospective analysis of a prospectively collected surgical database from an OCONUS military treatment facility over a 2-year period (2019\u20132021) was queried. Patient and procedural data were collected to include ACDF or CDA surgery, military rank, age, tobacco use, pre- and post-operative visual analogue scales for pain, and presence of radiographic fusion after surgery for ACDF patients or heterotopic ossification for CDA patients. Chi-square and Student t-test analyses were performed to identify variables associated with return to full duty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 47 patients (25 ACDF and 22 CDA) underwent surgery with an average follow-up of 192.1\u2009days (range 7\u2013819\u2009days). Forty-one (87.2%) patients were able to return to duty without restrictions; 10.6% of patients remained on partial or limited duty at latest follow-up and one patient was medically separated from the surgical cohort. There was one complication and one patient required tour curtailment from overseas duty for ongoing symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both ACDF and CDA are effective and safe surgical procedures for active duty patients with cervicalgia, cervical radiculopathy, and cervical myelopathy. They can be performed OCONUS with minimal interruption to the patient, their family, and the military unit, while helping to maintain surgical readiness for the surgeon and the military treatment facility.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad280","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T12:51:40Z","timestamp":1690289500000},"page":"e3454-e3462","source":"Crossref","is-referenced-by-count":1,"title":["Effect of\u00a0Fusion and\u00a0Arthroplasty for\u00a0Cervical Degenerative Disc Disease in\u00a0Active Duty Service Members Performed at an Overseas Military Treatment Facility: A 2-Year Retrospective Analysis"],"prefix":"10.1093","volume":"188","author":[{"given":"Callum","family":"Dewar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijay M","family":"Ravindra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Naval Medical Center San Diego , San Diego, CA 92134, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Woodle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michaela","family":"Scanlon","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Shields","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hana","family":"Yokoi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Meister","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Porensky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Naval Medical Center San Diego , San Diego, CA 92134, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Bossert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7615-4589","authenticated-orcid":false,"given":"Daniel S","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"issue":"1","key":"2023110723524554700_R1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/BSD.0b013e31820d77ea","article-title":"Incidence and\u00a0epidemiology of\u00a0cervical radiculopathy in\u00a0the United States military: 2000 to 2009","volume":"25","author":"Schoenfeld","year":"2012","journal-title":"J Spinal Disord Tech"},{"issue":"9711","key":"2023110723524554700_R2","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/S0140-6736(09)61797-9","article-title":"Diagnoses and\u00a0factors associated with medical evacuation and\u00a0return to duty for\u00a0service members participating in\u00a0Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study","volume":"375","author":"Cohen","year":"2010","journal-title":"Lancet"},{"issue":"4","key":"2023110723524554700_R3","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3171\/spi.2005.2.4.0403","article-title":"Early results after ProDisc-C cervical disc replacement","volume":"2","author":"Bertagnoli","year":"2005","journal-title":"J Neurosurg Spine"},{"issue":"6","key":"2023110723524554700_R4","doi-asserted-by":"publisher","first-page":"344","DOI":"10.3928\/01477447-20180815-01","article-title":"Superiority of\u00a02-level total disk replacement using a cervical disk prosthesis versus anterior cervical diskectomy and\u00a0fusion","volume":"41","author":"Yang","year":"2018","journal-title":"Orthopedics"},{"issue":"6","key":"2023110723524554700_R5","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.spinee.2018.12.013","article-title":"The NECK trial: effectiveness of\u00a0anterior cervical discectomy with or without interbody fusion and\u00a0arthroplasty in\u00a0the treatment of\u00a0cervical disc herniation; a double-blinded randomized controlled trial","volume":"19","author":"Vleggeert-Lankamp","year":"2019","journal-title":"Spine J"},{"issue":"2","key":"2023110723524554700_R6","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.spinee.2020.10.013","article-title":"Comparison of\u00a0adverse events between cervical disc arthroplasty and\u00a0anterior cervical discectomy and\u00a0fusion: a 10-year follow-up","volume":"21","author":"Loidolt","year":"2021","journal-title":"Spine J"},{"issue":"3","key":"2023110723524554700_R7","doi-asserted-by":"publisher","first-page":"252","DOI":"10.3171\/2017.5.SPINE16824","article-title":"Prospective, randomized multicenter study of\u00a0cervical arthroplasty versus anterior cervical discectomy and\u00a0fusion: 5-year results with a metal-on-metal artificial disc","volume":"28","author":"Coric","year":"2018","journal-title":"J Neurosurg Spine"},{"issue":"8","key":"2023110723524554700_R8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.19606","article-title":"Effect of\u00a0arthroplasty vs\u00a0fusion for\u00a0patients with cervical radiculopathy: a randomized clinical trial","volume":"4","author":"Johansen","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"2023110723524554700_R9","doi-asserted-by":"publisher","DOI":"10.3171\/2018.9.FOCUS18380","article-title":"Return-to-active-duty rates after anterior cervical spine surgery in\u00a0military pilots","volume":"45","author":"Miller","year":"2018","journal-title":"Neurosurg Focus"},{"issue":"12","key":"2023110723524554700_R10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017434","article-title":"Accuracy of\u00a0recall of\u00a0musculoskeletal injuries in\u00a0elite military personnel: a cross-sectional study","volume":"7","author":"Lovalekar","year":"2017","journal-title":"BMJ Open"},{"issue":"10","key":"2023110723524554700_R11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-007943","article-title":"Musculoskeletal pain and\u00a0limitations in\u00a0work ability in\u00a0Swedish marines: a cross-sectional survey of\u00a0prevalence and\u00a0associated factors","volume":"5","author":"Monnier","year":"2015","journal-title":"BMJ Open"},{"issue":"2","key":"2023110723524554700_R12","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1227\/NEU.0b013e318258e1da","article-title":"Rate of\u00a0return to military active duty after single level lumbar interbody fusion: a 5-year retrospective review","volume":"71","author":"Tumial\u00e1n","year":"2012","journal-title":"Neurosurgery"},{"key":"2023110723524554700_R13","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usac193","article-title":"Lumbar fusion for\u00a0active duty service members performed at an overseas military treatment facility: a 2-year retrospective analysis","author":"Ikeda","year":"2022","journal-title":"Mil Med"},{"issue":"1","key":"2023110723524554700_R14","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1093\/neuros\/nyy230","article-title":"Rate of\u00a0return to military active duty after single and\u00a02-level anterior cervical discectomy and\u00a0fusion: a 4-year retrospective review","volume":"85","author":"Tumial\u00e1n","year":"2019","journal-title":"Neurosurgery"},{"issue":"2","key":"2023110723524554700_R15","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/BRS.0b013e31819286ea","article-title":"Predictors of\u00a0outcome after anterior cervical discectomy and\u00a0fusion: a multivariate analysis","volume":"34","author":"Anderson","year":"2009","journal-title":"Spine"},{"issue":"3","key":"2023110723524554700_R16","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/BSD.0b013e31819e31a4","article-title":"A retrospective analysis of\u00a0patient perceived outcomes in\u00a0patients 55 years and\u00a0older undergoing anterior cervical discectomy and\u00a0fusion","volume":"23","author":"Gray","year":"2010","journal-title":"J Spinal Disord Tech"},{"issue":"5","key":"2023110723524554700_R17","doi-asserted-by":"publisher","first-page":"420","DOI":"10.3171\/SPI\/2008\/8\/5\/420","article-title":"Radiographic and\u00a0clinical outcomes following single-level anterior cervical discectomy and\u00a0allograft fusion without plate placement or cervical collar","volume":"8","author":"Jagannathan","year":"2008","journal-title":"J Neurosurg Spine"},{"issue":"3","key":"2023110723524554700_R18","doi-asserted-by":"crossref","first-page":"607","DOI":"10.2106\/00004623-195840030-00009","article-title":"The treatment of\u00a0certain cervical-spine disorders by anterior removal of\u00a0the intervertebral disc and\u00a0interbody fusion","volume":"40-A","author":"Smith","year":"1958","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"2023110723524554700_R19","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.16739","article-title":"Investigational research: timeline, trials, and\u00a0future directions of\u00a0spinal disc arthroplasty","volume":"13","author":"Fiani","year":"2021","journal-title":"Cureus"},{"issue":"11","key":"2023110723524554700_R20","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1016\/j.jocn.2014.05.007","article-title":"Outcomes of\u00a0single-level cervical disc arthroplasty versus anterior cervical discectomy and\u00a0fusion","volume":"21","author":"Tracey","year":"2014","journal-title":"J Clin Neurosci"},{"issue":"1","key":"2023110723524554700_R21","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3113\/jsoa.2013.0010","article-title":"Outcomes following cervical disc arthroplasty in\u00a0an active duty military population","volume":"22","author":"Kang","year":"2013","journal-title":"J Surg Orthop Adv"},{"issue":"3","key":"2023110723524554700_R22","doi-asserted-by":"publisher","first-page":"e1790","DOI":"10.7205\/MILMED-D-16-00085","article-title":"Outcomes following multilevel cervical disc arthroplasty in\u00a0the young active population","volume":"182","author":"Zarkadis","year":"2017","journal-title":"Mil Med"},{"issue":"2","key":"2023110723524554700_R23","first-page":"110","article-title":"Occupational impact of\u00a0multilevel cervical disease treated with hybrid cervical disc arthroplasty in\u00a0active duty military population","volume":"25","author":"Cleveland","year":"2016","journal-title":"J Surg Orthop Adv"},{"issue":"11","key":"2023110723524554700_R24","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.7205\/MILMED-D-14-00702","article-title":"The occupational impact of\u00a0single-level cervical disc arthroplasty in\u00a0an active duty military population","volume":"180","author":"Cleveland","year":"2015","journal-title":"Mil Med"},{"issue":"2","key":"2023110723524554700_R25","doi-asserted-by":"publisher","DOI":"10.3171\/foc.1998.5.2.9","article-title":"The influence of\u00a0secondary gain on\u00a0surgical outcome: a comparison between cervical and\u00a0lumbar discectomy","volume":"5","author":"Kaptain","year":"1998","journal-title":"Neurosurg Focus"},{"issue":"3","key":"2023110723524554700_R26","doi-asserted-by":"publisher","DOI":"10.1016\/s0090-3019(99)00087-7","article-title":"Secondary gain influences the outcome of\u00a0lumbar but not cervical disc surgery","volume":"52","author":"Kaptain","year":"1999","journal-title":"Surg Neurol"},{"key":"2023110723524554700_R27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jor.2023.04.008","article-title":"Return to sport and\u00a0active military duty after cervical disc arthroplasty: a systematic review","volume":"39","author":"Reiter","year":"2023","journal-title":"J Orthop"},{"issue":"4","key":"2023110723524554700_R28","doi-asserted-by":"publisher","first-page":"273","DOI":"10.3171\/spi.2006.4.4.273","article-title":"Effect of\u00a0approach side during anterior cervical discectomy and\u00a0fusion on\u00a0the incidence of\u00a0recurrent laryngeal nerve injury","volume":"4","author":"Kilburg","year":"2006","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"2023110723524554700_R29","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1097\/00007632-200106150-00014","article-title":"Recurrent laryngeal nerve injury with anterior cervical spine surgery risk with laterality of\u00a0surgical approach","volume":"26","author":"Beutler","year":"2001","journal-title":"Spine"},{"key":"2023110723524554700_R30","article-title":"Top army surgeon blasts military\u2019s capability to handle war traumas","volume-title":"US News & World Report","author":"Sternberg","year":"2019"},{"key":"2023110723524554700_R31","article-title":"A crack in\u00a0the armor: surgeons see a military hospital as a shadow of\u00a0its past","volume-title":"US News & World Report","author":"Sternberg","year":"2019"},{"issue":"Suppl 1","key":"2023110723524554700_R32","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1093\/milmed\/usz263","article-title":"Maintaining surgical readiness while deployed to low-volume military treatment facilities: a pilot program for\u00a0clinical and\u00a0operational sustainment training in\u00a0the deployed environment","volume":"185","author":"Gurney","year":"2020","journal-title":"Mil Med"},{"issue":"1","key":"2023110723524554700_R33","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1001\/jamasurg.2021.5331","article-title":"Analysis of\u00a0surgical volume in\u00a0military medical treatment facilities and\u00a0clinical combat readiness of\u00a0us military surgeons","volume":"157","author":"Dalton","year":"2022","journal-title":"JAMA Surg"},{"issue":"7-8","key":"2023110723524554700_R34","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1093\/milmed\/usaa543","article-title":"Trends in\u00a0surgical volume in\u00a0the military health system\u2014a potential threat to mission readiness","volume":"186","author":"Haag","year":"2021","journal-title":"Mil Med"},{"key":"2023110723524554700_R35","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usac229","article-title":"Initial assessment of\u00a0a regional military-civilian partnership on\u00a0trauma surgery skills sustainment","author":"Ruggero","year":"2022","journal-title":"Mil Med"},{"issue":"1","key":"2023110723524554700_R36","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2018-000274","article-title":"Objective model to facilitate designation of\u00a0military\u2013civilian partnership hospitals for\u00a0sustainment of\u00a0military trauma readiness","volume":"4","author":"Hall","year":"2019","journal-title":"Trauma Surg Acute Care Open"},{"article-title":"Novel synchronous augmented reality surgical mentoring system in\u00a0the performance of\u00a0trauma procedures: initial results of\u00a0the ARTEMIS study","year":"2022","author":"Tadlock","key":"2023110723524554700_R37"},{"key":"2023110723524554700_R38","doi-asserted-by":"publisher","first-page":"e1335","DOI":"10.1016\/j.wneu.2022.09.033","article-title":"Attitudes toward neurosurgery education for\u00a0the nonneurosurgeon: a survey study and\u00a0critical analysis of\u00a0U.S. military training techniques and\u00a0future prospects","author":"Ravindra","year":"2022","journal-title":"World Neurosurg"},{"issue":"5-6","key":"2023110723524554700_R39","doi-asserted-by":"publisher","first-page":"e632","DOI":"10.1093\/milmed\/usaa531","article-title":"Transpacific aeromedical evacuation for\u00a0a ruptured brain arteriovenous malformation during the COVID-19 pandemic","volume":"186","author":"Ikeda","year":"2021","journal-title":"Mil Med"},{"key":"2023110723524554700_R40","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2023.107742","article-title":"Craniotomies at an overseas military treatment facility: maintaining readiness for\u00a0the unit and\u00a0the surgeon","volume":"230","author":"Woodle","year":"2023","journal-title":"Clin Neurol Neurosurg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/11-12\/e3454\/52810285\/usad280.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/11-12\/e3454\/52810285\/usad280.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T23:53:40Z","timestamp":1699401220000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/11-12\/e3454\/7230554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":40,"journal-issue":{"issue":"11-12","published-online":{"date-parts":[[2023,7,25]]},"published-print":{"date-parts":[[2023,11,3]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad280","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,7,25]]}}}