Physical Therapy Following Cervical Surgery – Flashcards
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Who needs surgery?
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-Fractures -Instability -Radiculopathy -Myelopathy
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Cervical radiculopathy RCT research for research
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-Improvement in short term (1 year) but no difference long term (2 years) for surgery compared to conservative -Trial of conservative warranted for patients with cervical radiculopathy
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Surgery for radiculopathy
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Surgery reserved for patients with lack of improvement or progressive neurological deterioration
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Cervical myelopathy: Who should have surgery
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-20-60% with clinical findings of myelopathy may deteriorate at 3-6 year follow up
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Patients with imaging findings of cord compression from spondylosis
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8% at 1 year and 23% at 44 months may develop clinical findings
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What percentage of people over 70 have imaging evidence of cervical spondylosis (OA)?
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95% of males and 70% of females
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ACDF
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Anterior cervical discectomy and fusion Most commonly performed cervical surgery for cervical radiculopathy or myelopathy secondary to cervical degenerative disc disease
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What percentage of people who have an ACDF have ongoing neck pain at 1 year?
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Up to 70%
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Re-operation rates of ACDF
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Re-operation rate between 6-14% at 2 years
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Side effects of ACDF
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Adjacent segment cervical disease occurs in up to 25% within 10 years
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Other potential surgeries involve what approach/
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Posterior: laminectomy with fusion
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ACDF procedure
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-~4 cm in the anterior cervical region, extending from midline to the medial border of the sternocleidomastoid muscle -The longus colli muscle is retracted to access the disc and vertebral bodies -Hardware is surgically secured to provide stability to the targeted vertebral bodies
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What type of bone grafts are typically used in ACDF
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Autologous Cadaver Synthetic bone grafting
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Potential post surgical complications
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-Dysphagia and hoarseness (recurrent laryngeal nerve) -Delayed or failed fusion (smoking a risk factor) -Hardware fracture -Adjacent segment degeneration -Residual neurological deficits and arm or neck pain
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Post operative rehabilitation: Immobilization
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Neck may be immobilized in rigid collar for 4-6 weeks Depends on surgeon, number of levels fused, type of bone graft
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Post operative rehabilitation: lifting restrictions
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No greater than 5 pounds for 4-6 weeks
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When is PT typically started after surgery?
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PT generally started after 4-6 weeks
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PT evaluation
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-Assess cervical and thoracic range/mobility -Assess neurological status -Assess upper limb neurodynamics -Assess motor control/ endurance (deep neck flexors, cervical extensors, scapular stabilizers) -Assessment of sensorimotor -Common psychosocial factos
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Assessment of sensorimotor
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Position sense, eye follow, gaze stability, balance
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Psychosocial factors
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Fear of movement, anxiety, depression , pain catastrophizing
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Cervical ROM exercises
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Flexion, extension, rotation
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Thoracic mobility exercise
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Cat/camel, seated extension, sidelying rotation
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Initial PT exercises:
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-Cervical ROM exercise -Thoracic mobility exercise -Low load deep neck flexor and scapular muscle exercises -UE nerve glides as needed (sliders initially) -Cervical sensory motor training as needed -Aerobic exercise -Manual therapy
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Manual therapy
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Thoracic spine mobilization/ manipulation Scar mobilization
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Fear avoidant patients
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Encourage gradual increase in activity
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Poor pacers
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People who overdo it Encourage intermittent activity/ rest
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Not sleeping well
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Problem solve sleeping positions, consider medication prior to bed
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Ergonomics
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Will vary by individual needs but may be helpful to work on strategies to minimize neck strain
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Ongoing neck/arm pain or neurological symptoms
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Explain that this is very common and may take some time for the system to desensitize as tissues heal
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PT progressions
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-Continue with mobility exercise and manual therapy as needed -Cervical extensor muscle exercises -UE PRE's (be aware of any lifting restrictions) -Job or sport specific activities
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Can you perform manual mobilization of the cervical spine after ACDF?
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Mobilizing adjacent segments is generally safe (for example lower cervical spine fused can mobilized upper cervical or CT junction) -When in doubt, check with the surgeon
