***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Many patients with cervical disc disease require leave from work , due to long-lasting , complex symptoms , including chronic pain and reduced levels of physical and psychological function . Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits , but not the non-specific neck pain and the frequent illness . No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery . The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease , with respect to function , disability , work capability , and cost effectiveness . Methods / Design This study was design ed as a prospect i ve , r and omised , controlled , multi-centre study . An independent , blinded investigator will compare two alternatives of rehabilitation . We will include 200 patients of working age , with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression . After providing informed consent , study participants will be r and omised to one of two alternative physiotherapy regimes ; ( A ) customary treatment ( information and advice on a specialist clinic ) ; or ( B ) customary treatment plus active physiotherapy . Physiotherapy will follow a st and ardised , structured programme of neck-specific exercises combined with a behavioural approach . All patients will be evaluated both clinical ly and subjectively ( with question naires ) before surgery and at 6 weeks , 3 months , 6 months , 12 months , and 24 months after surgery . The main outcome variable will be neck-specific disability . Cost-effectiveness will also be calculated . Discussion We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease . Trial registration Clinical Trials.gov identifier : Study Design : Retrospective review of the prospect i ve American College of Surgeons National Surgical Quality Improvement Project ( ACS NSQIP ) data base with 30-day follow-up of 2164 patients undergoing elective anterior cervical discectomy and fusion ( ACDF ) .  Objective : To determine factors independently associated with increased length of stay ( LOS ) and complications after ACDF to facilitate preoperative planning and setting of realistic expectations for patients and providers . Summary of Background Data : The effect of individual preoperative factors on LOS and complications has been evaluated in small-scale studies . Large data base analysis with multivariate analysis of these variables has not been reported . Methods : The  ACS NSQIP data base from 2005 to 2010 was  queried  for patients undergoing ACDF procedures .  Preoperative and perioperative variables were collected . Multivariate regression determined significant predictors ( P<0.05 ) of extended LOS and complications . Results : Average LOS was 2.0±4.0 days ( mean±SD ) with a range of 0–103 days . By multivariate analysis , age 65 years and above , functional status , transfer from facility , preoperative anemia , and diabetes were the preoperative factors predictive of extended LOS . Major complications , minor complications , and extended surgery time were the perioperative factors associated with increased LOS . The elongating effect of these variables was determined , and ranged from 0.5 to 5.0 days . Seventy-one patients ( 3.3 % ) had a total of 92 major complications , including return to operating room ( 40 ) , venous thrombotic events ( 13 ) , respiratory ( 21 ) , cardiac ( 6 ) , mortality ( 5 ) , sepsis ( 4 ) , and organ space infection ( 3 ) . Multivariate analysis determined ASA score ≥3 , preoperative anemia , age 65 years and above , extended surgery time , and male sex to be predictive of major complications ( odds ratios ranging between 1.756 and 2.609 ) . No association was found between levels fused and LOS or complications . Conclusion : Extended LOS after ACDF is associated with factors including age , anemia , and diabetes , as well as the development of postoperative complications . One in 33 patients develops a major complication postoperatively , which are associated with an increased LOS of 5 days Objectives The aims of this study are to answer the following questions ( 1 ) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years ? ( 2 ) Which sociodemographic , medical , work-related , and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients ? Methods The baseline survey ( T0 ; n = 534 ) was conducted 3.6 days ( SD 2.48 ) post-surgery in the form of face-to-face interviews . The follow-up interviews were conducted 3 months ( T1 ; n = 486 patients ) , 9 months ( T2 ; n = 457 ) , 15 months ( T3 ; n = 438 ) , and 5 years ( T4 ; n = 404 ) post-surgery . Pain intensity was measured on a numeric rating-scale ( NRS 0–100 ) . Estimated changes to and influences on postoperative pain by r and om effects were accounted by regression models . Results Average pain decreased continuously over time in patients with lumbar herniated disc ( Wald Chi² = 25.97 , p<0.001 ) . In patients with cervical herniated disc a reduction of pain was observed , albeit not significant ( Chi² = 7.02 , p = 0.135 ) . Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients : the subjective prognosis of gainful employment ( p<0.001 ) and depression ( p<0.001 ) . Conclusion In the majority of disc surgery patients , a long-term reduction of pain was observed . Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients . A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain . The findings may promote multimodal rehabilitation concepts including psychological and work-related support Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases with age . More women experience high‐disability neck pain than men . Wave analysis suggests that the point prevalence and 6‐month prevalence of high‐intensity and low‐disability neck pain are overestimated in this survey . Conclusion . This cross‐sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) of the adult population Study Design . Prospect i ve cohort study . Objective . To examine differences between preoperative and postoperative fear of movement and investigate the relationship between fear of movement and pain , disability and physical health after spinal surgery for degenerative conditions . Summary of Background Data . Consistent evidence supports the relationship between fear of movement and higher levels of pain and disability in various chronic pain population s. Fear of movement among patients undergoing spinal surgery for chronic pain has received little attention in the literature . Methods . Participants were 141 patients treated with surgery for lumbar and cervical degenerative conditions . Assessment s were conducted before surgery and 6 weeks and 3 months after hospitalization . Fear of movement was measured with the Tampa Scale for Kinesiophobia and outcomes were measured with the Brief Pain Inventory , Oswestry or Neck Disability Index , and 12-Item Short Form Health Survey ( SF-12 ) . Results . Follow-up rates were 91 % and 87 % for 6 weeks and 3 months , respectively . Fear of movement beliefs improved after surgery , but 49 % of patients continued to have high fear of movement at 6-week follow-up and 39 % at 3-month follow-up . Patients with higher levels of fear of movement had poorer postoperative outcomes . Multilevel linear regression analyses found that postoperative fear of movement was independently associated with postoperative pain intensity , pain interference , disability , and physical health ( P < 0.001 ) , after controlling for depression , age , sex , education , race , comorbidities , type and area of surgery , prior surgeries , and baseline outcome score . Preoperative fear of movement was not predictive of poorer surgical outcomes . Conclusion . Results demonstrate that postoperative but not preoperative fear of movement beliefs explain unique and significant variance in postoperative pain , disability , and physical health . Clinicians interested in improving surgical outcomes should address postoperative fear of movement along with other traditional clinical and medical risk factors . Recommendations include postoperative screening for high fear of movement beliefs and incorporating cognitive-behavioral techniques into postoperative rehabilitation for at-risk surgical spine patients BACKGROUND CONTEXT Spinal surgery in the workers compensation population shows evidence of less favorable outcomes than in general health cases . Although spine surgery has been alleged to be a cause of poor outcomes , such outcomes may be improved by appropriate postsurgical rehabilitation . PURPOSE To compare objective demographic , physical and psychological measurements and socioeconomic outcomes of treatment in work-related disabling cervical pain for the combination of anterior cervical fusion ( ACF ) plus functional restoration , compared with rehabilitation alone . STUDY DESIGN / SETTING A prospect i ve study of patients undergoing ACF for degenerative disc disease before rehabilitation for work-related musculoskeletal disorders versus neck pain unoperated controls , with data collected in an outpatient tertiary interdisciplinary rehabilitation setting . PATIENT SAMPLE A group of 52 patients completed a functional restoration treatment program after undergoing ACF ( Group S ) at one or two levels for degenerative cervical disc disease . During the study period , 625 patients with work-related neck pain were identified from the same study population , from which a  rehabilitation ( Group R ) comparison group ( n=150 ) was identified who were stratified according to the number and location of other compensable body parts . OUTCOME MEASURES Socioeconomic outcomes relevant to chronic disabling work-related cervical spinal disorders are reported based on 1-year posttreatment interviews . Pre- to posttreatment assessment of pain intensity , disability , depression and cumulative physical capability were assessed prospect ively . METHODS All patients were totally or partially disabled before completing an  intensive , medically supervised , functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach . Preprogram preparation included drug detoxification , psychotropic medication management and preparatory aerobic and mobility training . The intensive treatment phase involved strength and endurance training , with counseling geared to goals of work return and fitness maintenance . The 1-year structured clinical interview had a contact rate of 93 % to 95 % , and partial information acquisition on all patients . RESULTS Although Group S had lower work return and work retention outcomes , the differences were not significant . Group S patients had significantly more health utilization from a new provider in the year after completion of functional restoration ( 46 % vs 24 % ; OR=2.7 [ 1.3 , 5.3 ] , p<.004 ) . Group S patients were also more likely to be depressed , both at pre- and postrehabilitation . There were no significant differences in recurrent injury , additional surgery , physical measures or pain/disability self-report between the groups . CONCLUSIONS Workers compensation patients with chronic disabling work-related cervical spinal disorders who undergo a cervical fusion , combined with functional restoration , have socioeconomic outcomes after their surgery statistically similar to those for unoperated controls . Surgery patients had a higher rate of additional health-care-seeking behaviors from new providers and a greater likelihood of being clinical ly depressed before and after rehabilitation . This study suggests that cervical fusion for degenerative disc disease in workers compensation patients is not contraindicated , as long as interdisciplinary rehabilitation is available for complex cases after the surgical procedure Cervical total disk arthroplasty has proven to be an effective and safe alternative for anterior cervical diskectomy and fusion ( ACDF ) for the treatment of cervical disk degenerative disease . However , whether and when cervical 
    Output:
    
There are low- to very-low- quality evidence that some interventions ( use of cervical collars after non-plated anterior cervical diskectomy an fusion , structured physiotherapy , and interactive patients ’ education ) provide some benefit within functioning , pain , and selected psychological variables in patients undergoing cervical disk surgery .
Conclusion : There is insufficient evidence with few trials of low quality to allow any conclusion to be drawn about the effectiveness , harms , and general ineffectiveness of rehabilitation for people who have had cervical disk surgery for pain or radiculopathy