Cervical Fusion

what are the pre-op risk factors for cervical fusion?

degeneration, arthritis, structural changes, pervious surgeries, smoking

what are the post-op risk factors for cervical fusion?

dysphagia, healing and equipment complications, adjacent segment disease, pseudo-arthritis, C5 and laryngeal nerve palsy

what are the indications for cervical fusion?

include cervical radiculopathy, cervical myelopathy, instability, traumatic injury(such as high impact causing axial burst, whiplash-style trauma), pathological fractures, and certain degenerative conditions.

what are the three primary advantages of cervical fusion?

elimination of segmental motion, reduced mechanical stress, decreased recurrence

what are absolute contraindications of cervical fusion?

active infection, medically unstable that makes surgery unsafe, severe osteoporosis or inadequate bone quality

what are the anticipated clinical outcomes of cervical fusion?

good to excellent outcomes: rapid radicular pain relief, surgery + PT yielded faster improvement than just PT alone, and stabilization of neurological function (direct decompression halts progressive myelopathic spinal cord degeneration)

what are the biomechanical alterations of cervical fusion?

• decreased ROM at the fused segment

• adjacent segment hypermobility

• expedite degenerative processes

• alter overall spinal mechanics

what are the post surgical complications of cervical fusion?

throat discomfort, neurological complications (myelopathy, radiculomyelopahty, and recurrent laryngeal nerve palsy in 1-4% of post-surgical pts), and surgical and systemic complications in high risk patient demographic (pts aged over 65 years)

what is the general consensus for immobilization after cervical fusion?

immobilize after trauma, least agreement for 1-2 level posterior cervical fusion, dependent on number of levels fused but usually around 6-12 weeks with variability based on patient factors and surgeon preference.

what are the general guidelines for the maximum protection phase?

• pt education

• wound management and pain control

• bed mobility

• bracing

• exercise requires clearance, AROM to tolerance, isometrics, CV is cleared and wound closed

what is the general time frame for the protective approach for the anterior approach vs the posterior approach?

• anterior generally 1-6 weeks

• posterior generally 1-12 weeks

what are the contraindications for the posterior approach?

no NSAIDs, no driving while on narcotics, no tobacco

what are the contraindications for the anterior approach?

no lifting over 10 pounds, push/pulling (yardwork, chores) >20 lbs up to 3 months post-op, end range cervical stretching/movements, overhead lifting

important exercises during protective phase for cervical fusions?

walking, exercises that can be performed in supine, bed mobility

criteria for advancement from protective to controlled motion?

time- PT begins at 4-6 weeks post anterior approach, around 12 weeks for post posterior approach

what are the contraindications to the controlled motion phase after a cervical fusion?

no joint manipulations at fusion levels, surgeon’s protocol (typically no heavy lifting over 10 pounds for up to 3 months, limitations in active motions), no extension exercises/prone press up if there is also a laminectomy, no overhead lifting, no end range stretching or movements, no full cervical AROM or prone exercises, no submersion of the incision in water until fully healed, no running/horseback riding/high impact, no sitting more than 30-45 minutes at one time

what is the criteria for advancement from the controlled motion phase to the protective phase?

• functional shoulder AROM, cervical AROM improvements

• UE strength up to 12 pounds

• improved endurance and walking endurance

• controlled pain

general treatments for controlled motion phase?

• scar and soft tissue mobility

• progressive ROM and stretching of restricted tissues

• grade I/II mobs

• muscle perfomance with cervical isos, UE extremity strengthening, core co-activation, LE strengthening, chin tucks

• gait training

what are the contraindications for the return to function phase?

• lifting limited to 20 pounds up to 3 months, can increase 5 pounds every other week starting at 3 mos

• avoid tobacco

• high impact acitivities can begin at 6 mos (running, horseback riding)

• progress to planks and dead lifting at 6 mos

• NSAIDs can be used for posterior approach by 6 mos

what is the criteria for discharge?

• proper sitting/standing posture

• return to PLOF

• minimal to no pain with all or most activities

• cervical AROM within normal limits

• independent with HEP

• achieve MCID no NDI

• tolerate work simulation without symptom increase

• volitional DNF contraction for 10×10 s

• complete progressive walking program