Improving Surgical Outcomes with Early Physical Therapy After Anterior Cervical Discectomy and Fusion
Abstract
Anterior cervical discectomy and fusion (ACDF) is the most common surgery for cervical spine degenerative conditions at both civilian and military health centers. Over the last three decades, there has been a substantial increase in the rate and associated costs of cervical spine surgery. Despite the increased utilization, up to 40% of patients report persistent pain and disability as well as dissatisfaction following ACDF surgery, and up to 20% of patients in the military have difficulty returning to duty and meeting criteria for a successful outcome. Opioid use has also been found to be high with up to 20% of patients reporting chronic opioid use at 1 year after cervical spine surgery. Physical therapy (PT) has been found to be beneficial for improving pain, disability, and function in patients with chronic neck pain. In particular, specific exercises that strengthen the deep neck muscles and improve neck mobility appear to be effective for reducing long-term pain and disability. While research efforts have found evidence for the benefits of PT in patients with chronic neck pain, little work has been done to study the effects of PT after cervical spine surgery. Patients with chronic neck pain have been found to have moderate to severe muscle and range of motion (ROM) deficits prior to surgery, which then progress during the acute postoperative period. Early PT has the potential to address these deficits and halt or slow the progression of muscle degeneration. Therefore, it is critical that rehabilitation specialists have an evidence-based PT program that can be delivered after ACDF, especially during the early postoperative period, in order to improve outcomes that are relevant and meaningful to both civilians and Service Members. This 4-year application is directly aligned with the Fiscal Year 2022 Peer Reviewed Medical Research Program Topic Area of Musculoskeletal Disorders and the Strategic Goal for this topic focused on the development and testing of strategies to increase quality of life or halt/slow disease progression for associated musculoskeletal disorders. The purpose of our proposed multicenter randomized controlled clinical trial is to understand the benefits of early postoperative PT in patients undergoing ACDF surgery at civilian and military health centers. PT within the first 3 months of spine surgery for chronic neck and/or arm pain has the potential to improve short- and long-term outcomes related to disability, pain, function, opioid utilization, and military readiness. In addition, attending early postoperative PT may increase muscle strength and endurance and neck ROM, which will help halt/slow the progression of muscle degeneration and deficits found in this patient population after surgery. This study will include 76 patients with a cervical degenerative condition, such as cervical stenosis, spondylosis, and degenerative spondylolisthesis, that undergo a 1- or 2-level ACDF procedure. Patients will be recruited from a civilian academic medical center and two military treatment facilities and randomized to either (1) early postoperative PT (2 weeks – 10 weeks after ACDF) or (2) delayed postoperative PT (12 weeks – 20 weeks after ACDF). The first year of the project will focus on finalizing study procedures and the PT interventions, the second and third years will involve patient recruitment and delivering the PT interventions, and the fourth year will focus on collecting patient outcomes up to 1 year after ACDF surgery. Results from the proposed study will provide an evidence-based PT intervention focused on specific neck exercises that can be immediately integrated into rehabilitation care in the civilian and military setting. This study will also provide critical data on the timing of PT after spine surgery for chronic neck and/or arm pain. Our structured PT program with home exercises will provide individuals with a greater chance of restoring function, returning to work/duty, and participating
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310300
Entities
People
- Kristin Archer Swygert
Organizations
- United States Army
- Vanderbilt University