Abstract
Objectives Early physical therapy (PT) with specific stabilization training has been shown to benefit individuals after lumbar spinal surgery but has not been studied in patients after cervical spine surgery. The primary purpose of this study was to compare clinical outcomes between early cervical spine stabilizer (ECS) training and usual care (UC) in patients after anterior cervical discectomy and fusion (ACDF) surgery. The secondary purpose was to determine test-retest reliability of strength and endurance tests of cervical spinal stabilizers in this patient population. Methods Forty participants who were scheduled for ACDF surgery were randomized into either the ECS group or the UC group. After surgery, participants received their assigned group intervention during their hospital stay and continued their assigned intervention for 12 weeks. All participants had phone follow-ups twice during the first 6 weeks to address questions or problems. Clinical outcome measures including pain level using the Numeric Pain Rating Scale (NPRS), disability level using the Neck Disability Index (NDI), Craniocervical Flexor Strength (CCF-S), and Craniocervical Flexor Endurance (CCF-E) were collected three times: before surgery and 6 and 12 weeks after surgery. Test-retest reliability was assessed in the first 10 participants. Results There was no significant interaction between the groups over time for any of the outcome measures. However, all participants made significant improvements in all four outcome measures at 6 and 12 weeks post surgery. The results showed good-to-excellent test-retest reliability for the CCF-S and CCF-E tests. Conclusions Both ECS training and UC resulted in the same amount of improvement at 6 and 12 weeks; therefore, both therapy approaches appear to have similar and positive effects on patients in their first 3 months of recovery after ACDF. Both the CCF-S and CCF-E tests can be used reliably to assess the strength and endurance of the cervical spinal stabilizers for patients after ACDF surgery. The study was registered with the ClinicalTrials.gov (NIH, U.S. National Library of Medicine, identifier # NCT01519115) Protocol Registration system.
Highlights
Physical therapy (PT) is not always a part of care following spine surgeries after patients are discharged from the hospital, it is an integral part of care after most other orthopedic surgeries, such as total knee or total hip arthroplasty [1]
It has been shown that many individuals with spine pathologies have motor control deficits, which further decrease their capability for spinal protection during position changes or balance [4,5,6,7,8,9]
The participants gave verbal feedback about following their group instructions. This was reported to the PI at follow-up testing at 6 and 12 weeks, which was general nonmeasurable information, especially since the PI was blinded to the group. Both CCF strength and endurance tests are reliable when used for patients after ACDF surgery
Summary
Physical therapy (PT) is not always a part of care following spine surgeries after patients are discharged from the hospital, it is an integral part of care after most other orthopedic surgeries, such as total knee or total hip arthroplasty [1]. Specific training of cervical spinal segmental stabilizers, including deep cervical flexors (DCF) and cervical multifidi (CM), has been shown to improve clinical outcomes in individuals with cervical spinal pathologies [10, 11, 13]. These smaller stabilizing muscles play a significant role in cervical spine stability, because of their ability to directly support the vertebral segments and their ability to reduce excessive pressure or stress forces on the intervertebral disc [8, 10, 11, 13]
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