16. When to initiate postoperative physical therapy in multilevel posterior cervical-thoracic fusions?

Abstract

BACKGROUND CONTEXT

The role of physical therapy (PT) in patients undergoing surgery for cervical spondylotic myelopathy is understudied and not well understood. Current literature reports varied effects on outcomes, and thus postoperative standards of care neither address nor include PT in post-op posterior cervico-thoracic fusions.

PURPOSE

The aim of this study was to analyze when neck strengthening exercise should be initiated after multilevel posterior cervical-thoracic fusions.

STUDY DESIGN/SETTING

Multicenter retrospective study.

PATIENT SAMPLE

A total of 105 adult spine patients.

OUTCOME MEASURES

Clinical and radiographic outcomes.

METHODS

Retrospective chart reviews were conducted between 2016-2020 on patients who underwent a ≥3 level posterior cervico-thoracic fusion with caudal levels as C7 and T1/T2. Prescription and completion of PT were study inclusion criteria. Demographic, clinical, and radiographic data was collected at structured intervals from preoperative to 2 years postoperative. Percent improvement for cervical lordosis, T1 slope and C2-C7 sagittal plumbline was compared at 2 weeks and 2 years postop. Visual analog scale (VAS) for pain and Oswestry Disability Index (ODI) scores were similarly analyzed.

RESULTS

In total, 105 patients were included in the study and were divided into two cohorts: those that initiated PT ≤ 6 weeks postop and those who initiated PT > 6 weeks postop. A total of 58 patients were included in the Early PT cohort, and 47 were included in the Late PT cohort. Demographically, the Early PT and Late PT cohorts were similar in age (62.8 vs 61.1 years, respectively) and predominantly female (64.5% vs 67.6%, respectively). No significant difference was reported between the groups in body mass index, with a mean of 30.7 for Early PT and 31.2 for Late PT. While both cohorts showed improvement in radiographic parameters and patient reported outcomes at 2 years postop, there were significant differences in level of improvement between the two groups. The Early PT group had a comparatively better % improvement in cervical lordosis (25.2% vs 14.2%); mean T1 slope (-5.6% vs -2.6%); and mean C2-C7 sagittal plumbline (-15.2% vs -11.7%). Patients who started PT ≤ 6 weeks postop also reported greater VAS % improvement 61.9% vs 41% and Oswestry Disability Index % improvement 46.3% vs 29.6% at 2 years post-op.

CONCLUSIONS

Patients who underwent a 3- or more-level posterior cervico-thoracic fusion and started PT at or before 6 weeks postop exhibited greater radiographic and patient reported outcomes benefits than those starting PT more than 6 weeks postop. The results of this study support the early initiation of neck strengthening PT in most uncomplicated post-cervical fusion adult patients.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.