Postoperative Physical Therapy for Cervical Total Disc Replacement: A Case Report.

Background and purpose: Cervical total disc replacement (CTDR) was developed to decompress nervous structures, preserve spinal biomechanics, and reduce postoperative complications such as nonunion or fracture. There is no published literature regarding the optimal content, timing and duration of postoperative physical therapy (PT) for CTDR. Therefore, the purpose of this case report is to describe the postoperative PT management and one-year outcomes of a subject with CTDR as it relates to pain, function and quality of life.

Case description: A 37-year-old male and Brazilian Jiu Jitsu athlete with cervical radiculopathy underwent a C5-C6 and C6-C7 discectomy with CTDR. The subject attended PT for 14 sessions across 16 weeks. Interventions included manual therapy (soft tissue and joint mobilization), therapeutic exercise targeting cervical spine, thoracic spine and upper extremity mobility and strength, and weightlifting body mechanics education. Radiographic confirmation of prosthesis placement and healing was monitored at postoperative weeks six and 12. The PT program was designed and progressed according to tissue healing timelines, subject response, clinical reasoning, and sport-specific demands.

Outcomes: Improvements were noted with Neck Disability Index (14% to 0%), Patient Specific Functional Scale (3.4/10 to 10/10), Short Form-12 Physical Score (+5.4) and Mental Score (+25.7), and Numeric Pain Rating Scale (2/10 to 0/10). Cervical active range of motion (in degrees) improved in all motions, and deep neck flexor endurance from 5-35 seconds.

Discussion: A multimodal PT program following CTDR based on tissue healing timelines and clinical reasoning improved pain, function and quality of life up to one year postoperatively without adverse effects in this athlete. # LEVEL OF EVIDENCE 4.