Early Self-directed Home Exercise Program After Anterior Cervical Discectomy and Fusion

Abstract

Study Design. Pilot randomized controlled trial. Objective. To examine the acceptability and preliminary safety and outcome effects of an early self-directed home exercise program (HEP) performed within the first 6 weeks after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Little is known regarding optimal postoperative management after ACDF. Methods. Thirty patients (mean ± standard deviation, age = 50.6 ± 11.0 years, 16 women) undergoing ACDF were randomized to receive an early HEP (n = 15) or usual care (n = 15). The early HEP was a 6-week self-directed program with weekly supportive telephone calls to reduce pain and improve activity. Treatment acceptability was assessed after the intervention period (6 weeks after surgery). Safety (adverse events, radiographic fusion, revision surgery) was determined at routine postoperative visits. Disability (Neck Disability Index), pain intensity (Numeric Rating Scale for neck and arm pain), physical and mental health (SF-12), and opioid use were assessed preoperatively, and at 6 weeks and 6 and 12 months after surgery by an evaluator blinded to group assignment. Results. Participants reported high levels of acceptability and no serious adverse events with the early HEP. No difference in fusion rate was observed between groups (P > 0.05) and no participants underwent revision surgery. The early self-directed HEP group reported lower 6-week neck pain than the usual care group (F = 3.3, P = 0.04, r 2 = 0.3, mean difference = −1.7 [−3.4; −0.05]) and lower proportion of individuals (13% vs. 47%) using opioids at 12 months (P = 0.05). No other between-group outcome differences were observed (P > 0.05). Conclusion. An early self-directed HEP program was acceptable to patients and has the potential to be safely administered to patients immediately after ACDF. Benefits were noted for short-term neck pain and long-term opioid utilization. However, larger trials are needed to confirm safety with standardized and long-term radiograph assessment and treatment efficacy. Level of Evidence: 2

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion

“…A recent study by Coronado et al [41] examined the feasibility and outcomes of an early self-directed home exercise program after ACDF. Similar to the results of our study, they did not find significant differences in their outcome measures between the early rehabilitation program and UC.…”

“…[40] Poor adherence could reduce the patient participation in their recovery following ACDF. Patient engagement in their recovery has been shown to improve outcomes in many previous spine surgery studies [12,14,16,41].…”

Association of Duration of Preoperative Opioid Use with Reoperation After One-level Anterior Cervical Discectomy and Fusion in Nonmyelopathic Patients

“…32,33 ERAS often requires that patients attend multiple outpatient appointments for psychological counseling and to promote gentle opioid cessation with an emphasis on pain coping and self-resilience. 33 Postoperative home exercise programs have also been shown to effectively reduce postoperative opioid usage, 34 whereas use of superficial cervical plexus blocks have surprising not been shown to have a significant effect. 35 To best reduce the risk of patients to have opioid-related reoperations, poor outcomes, and chronic usage, multifactorial strategies are needed, like the existing targeted ERAS programs.…”

The effects of rehabilitation following anterior cervical microdiscectomy and fusion surgery

“…Patients' age, comorbidities, and smoking status and the number of operated levels effect postoperative recovery. However, no common standard program has been developed to help patients adapt in terms of activities of daily living (5).…”

“…T he most commonly detected problem in the cervical region is cervical disk disease (4,13,15,16,21). Radiculopathy, mainly caused by cervical disk disease, responds to analgesics, physical therapy exercises, lifestyle modifications, and injection therapies administered by algology specialists (5). However, a portion of these patients does not respond to these treatments, leading to a refractory state, negatively affecting their social, private, and business lives.…”