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

Carol McFarland, Sharon Wang-Price, Charles R Gordon, Guy Otis Danielson, J Stuart Crutchfield, Ann Medley, Toni Roddey, Carol McFarland, Sharon Wang-Price, Charles R Gordon, Guy Otis Danielson, J Stuart Crutchfield, Ann Medley, Toni Roddey

Abstract

Objectives: Early physical therapy (PT) with specific stabilization training has been shown to benefit individuals after lumbar spinal surgery but has not been studied in patients after cervical spine surgery. The primary purpose of this study was to compare clinical outcomes between early cervical spine stabilizer (ECS) training and usual care (UC) in patients after anterior cervical discectomy and fusion (ACDF) surgery. The secondary purpose was to determine test-retest reliability of strength and endurance tests of cervical spinal stabilizers in this patient population.

Methods: Forty participants who were scheduled for ACDF surgery were randomized into either the ECS group or the UC group. After surgery, participants received their assigned group intervention during their hospital stay and continued their assigned intervention for 12 weeks. All participants had phone follow-ups twice during the first 6 weeks to address questions or problems. Clinical outcome measures including pain level using the Numeric Pain Rating Scale (NPRS), disability level using the Neck Disability Index (NDI), Craniocervical Flexor Strength (CCF-S), and Craniocervical Flexor Endurance (CCF-E) were collected three times: before surgery and 6 and 12 weeks after surgery. Test-retest reliability was assessed in the first 10 participants.

Results: There was no significant interaction between the groups over time for any of the outcome measures. However, all participants made significant improvements in all four outcome measures at 6 and 12 weeks post surgery. The results showed good-to-excellent test-retest reliability for the CCF-S and CCF-E tests.

Conclusions: Both ECS training and UC resulted in the same amount of improvement at 6 and 12 weeks; therefore, both therapy approaches appear to have similar and positive effects on patients in their first 3 months of recovery after ACDF. Both the CCF-S and CCF-E tests can be used reliably to assess the strength and endurance of the cervical spinal stabilizers for patients after ACDF surgery. The study was registered with the ClinicalTrials.gov (NIH, U.S. National Library of Medicine, identifier # NCT01519115) Protocol Registration system.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Carol McFarland et al.

Figures

Figure 1
Figure 1
Testing position for CCF-S and CCF-E measures of DCF strength and endurance.
Figure 2
Figure 2
Rehabilitation research and practice submission. (1) chin tuck, (2) seated chin tuck with thoracic extension and scapular retraction, (3) standing chin tuck with scapular retraction and depression, (4) seated chin tuck with abdominal drawing in, (5) standing bilateral rows with chin tuck, (6) bilateral shoulder external rotation with chin tuck, and (7) seated reach (a) and pull (b) with chin tuck.
Figure 3
Figure 3
Consort diagram.

References

    1. Maxey L., Magnusson J. Rehabilitation for the Postsurgical Orthopedic Patient. third ed. St. Louis, Missouri: Mosby Elsevier; 2013. Parts 2 through 4, post-operative care for upper and lower quarter.
    1. Sueki. Anterior Cervical Discectomy and Fusion. In: Maxey L., Magnusson J., editors. Rehabilitation for the Postsurgical Orthopedic Patient. third ed. St. Louis, Missouri: Mosby; 2013. pp. 256–282.
    1. McGregor A. H., Doré C. J., Morris T. P., Morris S., Jamrozik K. Function after spinal treatment, exercise and rehabilitation (FASTER): improving the functional outcome of spinal surgery. BMC Musculoskelet Disord. 2010;11(1) doi: 10.1186/1471-2474-11-17.
    1. Radebold A., Cholewicki J., Polzhofer G. K., Greene H. S. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001;26(7):724–730. doi: 10.1097/00007632-200104010-00004.
    1. Hodges P., Cholewicki J., Van Dieen J. Spinal Control: The Rehabilitation of Back Pain. State of the Art and Science. Edinburg: Churchill, Livingston, Elsevier; 2013.
    1. Kiesel K., Underwood F., Mattacola C., Nitz A., Malone T. A comparison of select trunk muscle thickness change between subjects with low back pain classified in the treatment-based classification system and asymptomatic controls. The Journal of Orthopaedic and Sports Physical Therapy. 2007;37(10):596–607. doi: 10.2519/jospt.2007.2574.
    1. Hides J., Gilmore C., Stanton W., Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Manual Therapy. 2008;13(1):43–49. doi: 10.1016/j.math.2006.07.017.
    1. Falla D. L., Jull G. A., Hodges P. W. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004;29(19):2108–2114. doi: 10.1097/01.brs.0000141170.89317.0e.
    1. Hodges P. W., Richardson C. A. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine. 1996;21(22):2640–2650. doi: 10.1097/00007632-199611150-00014.
    1. O'Leary S., Falla D., Elliott J. M., Jull G. Muscle dysfunction in cervical spine pain: implications for assessment and management. The Journal of Orthopaedic and Sports Physical Therapy. 2009;39(5):324–333. doi: 10.2519/jospt.2009.2872.
    1. O'Leary S., Falla D., Hodges P. W., Jull G., Vicenzino B. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. The Journal of Pain. 2007;8(11):832–839. doi: 10.1016/j.jpain.2007.05.014.
    1. Abbott A. D., Tyni-Lenne R., Hedlund R. Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Spine (Phila Pa 1976) 2010;35(8):848–857. doi: 10.1097/BRS.0b013e3181d1049f.
    1. O'Leary S., Jull G., Kim M., Vicenzino B. Cranio-cervical flexor muscle impairment at maximal, moderate, and low loads is a feature of neck pain. Manual Therapy. 2007;12(1):34–39. doi: 10.1016/j.math.2006.02.010.
    1. Hebert J. J., Marcus R. L., Koppenhaver S. L., Fritz J. M. Postoperative rehabilitation following lumbar discectomy with quantification of trunk muscle morphology and function: a case report and review of the literature. J Ortho p Sports Phys Ther. 2010;40(7):402–412. doi: 10.2519/jospt.2010.3332.
    1. Nielsen P. R., Andreasen J., Asmussen M., Tonnesen H. Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine. BMC Health Serv Res. 2008;8(1) doi: 10.1186/1472-6963-8-209.
    1. Oestergaard L., Nielsen C., Bünger C., et al. The effect of early initiation of rehabilitation after lumbar spinal fusion: a randomized clinical study. Spine. 2012;37(21):1803–1809. doi: 10.1097/BRS.0b013e31825a17ab.
    1. Kernc D., Strojnik V., Vengust R. Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2018;13(1):p. 151. doi: 10.1186/s13018-018-0853-7.
    1. Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Manual Therapy. 2004;9(3):125–133. doi: 10.1016/j.math.2004.05.003.
    1. Fleming R. Segmental Stabilization of the Cervical Spine. La Crosse, WI: Orthopaedic Section, American Physical Therapy Association; 2003. Wilmarth Mary A., ed. Physical Therapy for the Cervical Spine and Temporomandibular Joint; Module No. 3.
    1. Matz P. G., Holly L. T., Groff M. W., et al. Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. Journal of Neurosurgery. Spine. 2009;11(2):174–182. doi: 10.3171/2009.3.SPINE08720.
    1. Peolsson A., Vavruch L., Oberg B. Predictive factors for arm pain, neck pain, neck specific disability and health after anterior cervical decompression and fusion. Acta Neurochirurgica. 2006;148(2):167–173. doi: 10.1007/s00701-005-0660-x. 173.
    1. Grob D. Surgery in the degenerative cervical spine. Spine. 1998;23(24):2674–2683. doi: 10.1097/00007632-199812150-00005.
    1. Ylinen J. J., Savolainen S., Airaksinen O., Kautiainen H., Salo P., Hakkinen A. Decreased strength and mobility in patients after anterior cervical diskectomy compared with healthy subjects. Archives of Physical Medicine and Rehabilitation. 2003;84(7):1043–1047. doi: 10.1016/s0003-9993(03)00039-x.
    1. Hides J. A., Richardson C. A., Jull G. A. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine. 1996;21(23):2763–2769. doi: 10.1097/00007632-199612010-00011.
    1. Ward S. R., Kim C. W., Eng C. M., et al. Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. The Journal of Bone and Joint Surgery. American Volume. 2009;91(1):176–185. doi: 10.2106/JBJS.G.01311.
    1. Hodges P., Holm A. K., Hansson T., Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine. 2006;31(25):2926–2933. doi: 10.1097/01.brs.0000248453.51165.0b.
    1. Jull G., Falla D., Vicenzino B., Hodges P. W. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy. 2009;14(6):696–701. doi: 10.1016/j.math.2009.05.004.
    1. Jull G., O'Leary S., Falla D. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. Journal of Manipulative and Physiological Therapeutics. 2008;31(7):525–533. doi: 10.1016/j.jmpt.2008.08.003.
    1. Chiu T., Law E., Chiu T. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. The Journal of Orthopaedic and Sports Physical Therapy. 2005;35(9):567–571. doi: 10.2519/jospt.2005.35.9.567.
    1. Fernandez-de-las-Penas C., Perez-de-Heredia M., Molero-Sanchez A., Miangolarra-Page J. C. Performance of the craniocervical flexion test, forward head posture, and headache clinical parameters in patients with chronic tension-type headache: a pilot study. The Journal of Orthopaedic and Sports Physical Therapy. 2007;37(2):33–39. doi: 10.2519/jospt.2007.2401.
    1. Faul F., Erdfelder E., Lang A.-G., Buchner A. G∗Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(2):175–191. doi: 10.3758/bf03193146.
    1. Guzman J., FRCP, ELDC H., et al. A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4) S14-S23
    1. Pinto D., Robertson M. C., Hansen P., Abbott J. H. Good agreement between questionnaire and administrative databases for health care use and costs in patients with osteoarthritis. BMC Medical Research Methodology. 2011;11(1) doi: 10.1186/1471-2288-11-45.
    1. Evangelista L. S., Hamilton M. A., Fonarow G. C., Dracup K. Is exercise adherence associated with clinical outcomes in patients with advanced heart failure? The Physician and Sportsmedicine. 2010;38(1):28–36. doi: 10.3810/psm.2010.04.1759.
    1. Pisters M. F., Veenhof C., Schellevis F. G., Twisk J. W., Dekker J., De Bakker D. H. Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee. Arthritis Care Res (Hoboken). 2010;62(8):1087–1094. doi: 10.1002/acr.20182.
    1. Jordan J. L., Holden M. A., Mason E. E. J., Foster N. E., Cochrane Musculoskeletal Group Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews. 2010;(1) doi: 10.1002/14651858.CD005956.pub2.
    1. Rothrock R. J., Steinberger J. M., Badgery H., et al. Frailty status as a predictor of 3-month cognitive and functional recovery following spinal surgery: a prospective pilot study. The Spine Journal. 2019;19(1):104–112. doi: 10.1016/j.spinee.2018.05.026.
    1. Davis R. E., Vincent C., Henley A., McGregor A. Exploring the care experience of patients undergoing spinal surgery: a qualitative study. Journal of Evaluation in Clinical Practice. 2011;19(1):132–138. doi: 10.1111/j.1365-2753.2011.01783.x.
    1. Parker S. L., Asher A. L., Godil S. S., Devin C. J., McGirt M. J. Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms? Neurosurgical Focus. 2015;39(6) doi: 10.3171/2015.9.FOCUS15356.
    1. Forkan R., Pumper B., Smyth N., Wirkkala H., Ciol M. A., Shumway-Cook A. Exercise adherence following physical therapy intervention in older adults with impaired balance. Physical Therapy. 2006;86(3):401–410.
    1. Coronado R. A., Devin C. J., Pennings J. S., et al. Early self-directed home exercise program after anterior cervical discectomy and fusion: a pilot study. Spine (Phila Pa 1976) 2020;45(4):217–225. doi: 10.1097/BRS.0000000000003239.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa