Rehabilitation to Improve Outcomes after Cervical Spine Surgery: Narrative Review

Abstract

Purpose: The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in optimal recovery after cervical spine surgeries. Nevertheless, there is no agreement in the existing research regarding the most suitable postsurgical rehabilitation program. Consequently, this review assesses the ideal rehabilitation approach for adult patients following cervical spine operations.

Materials and methods: This review covers activities of daily living and encompasses diverse treatment methods, including physiotherapy, specialized tools, and guidance for everyday activities. The review is organized under three headings: (1) historical perspectives, (2) patient-reported functional outcomes, and (3) general and disease-specific rehabilitation.

Results: Rehabilitation programs are determined on the basis of patient-reported outcomes, performance tests, and disease prognosis. CSM requires strengthening of the neck and shoulder muscles that have been surgically invaded. In contrast, the CCI requires mobility according to the severity of the spinal cord injury and functional prognosis. The goal of rehabilitation for CCTs, as for CCIs, is to achieve ambulation, but the prognosis and impact of cancer treatment must be considered.

Conclusions: Rehabilitation of the cervical spine after surgery is essential for improving physical function and the ability to perform daily activities and enhancing overall quality of life. The rehabilitation process should encompass general as well as disease-specific exercises. While current rehabilitation protocols heavily focus on strengthening muscles, they often neglect the crucial aspect of spinal balance. Therefore, giving equal attention to muscle reinforcement and the enhancement of spinal balance following surgery on the cervical spine is vital.

Keywords: cervical spine; muscle exercise; physiotherapy; rehabilitation.

Figure 1

Ten-second Grip and Release Test. (A): Grip; (B): Release. A 10 s G&R of less than 20 times G&R is classified as hand dexterity impairment.

Figure 2

Foot Tapping Test.

Figure 3

(A): Isometric contraction of the extensor muscles of the neck. (B): Self-isometric exercise of neck extensor muscles. (C): Self-isometric exercise of neck flexor muscles. (D): Scapular elevation exercises. (E): Scapular rotation exercises. (F): Scapular adduction exercises. (G): Resistance exercise of the middle trapezius muscle. (H): Resistance exercise of the upper trapezius muscle.

Figure 4

Hand dexterity movement exercises: (A): Pinching action with pegboard. (B): Pinch Power Strengthening Exercise. (C): Cutting exercise using a knife, (D): Buttoning practice. (E): Hand dexterity movement exercises using a spoon. (F): Hand dexterity movement exercises using chopsticks.

Figure 5

Neural Mobilization (NM): (A): Neural Mobilization of the median nerve area (C5~7), (B): Neural Mobilization of the radial nerve area (C6~8), (C): Neural Mobilization of the ulnar nerve area (C8~Th1).

Figure 6

Balance ability exercise: (A): Stand on balance cushions and raise heels. (B): Stand with one foot on balance cushions and abduct the contralateral lower leg. (C): Stand on balance cushions and raise the ball. (D): Walk on a treadmill and react to changes in speed. (E): Center of gravity movement exercise using a TV game. (F): Knee walking on a platform. (Used for patients at high risk of falling).

Figure 7

The manual tracheal retraction exercise (TRE).

Figure 8

Suprahyoid muscle exercises: (A): Chin tack exercise, (B): Jaw opening exercise.

Figure 9

Physical therapy algorithm from Acute phase to Recovery phase [166].

Figure 10

Physical Therapy for CCI Patients: (A): Stretching the hamstrings. (B): Strengthening exercises for the serratus anterior muscle. (C): Push-ups to Prevent Pressure Ulcers. (D): Floor-to-wheelchair transfers. (E): Strengthening of trunk muscles for stabilization of sitting position. (F): Gait practice with a cane and lower limb orthosis.

Figure 11

Treatment of OH using tilt table and EMS.

Figure 12

Gait practice for SCI patients using body weight-bearing treadmill training (BWSTT) and robot-assisted gait training (RAGT). (A): Body weight-supported treadmill training, (B): Body weight-supported training with a walker.