Rehabilitation After Anterior Cervical Discectomy and Fusion (ACDF-REHAB)

This study is planned as a prospective, single-center, assessor-blinded, parallel-group randomized controlled clinical trial. The study will include 60 adults aged 18 to 70 years who have undergone elective single- or two-level anterior cervical discectomy and fusion (ACDF) for degenerative cervical disc disease, cervical disc herniation, and/or cervical radiculopathy.

After postoperative clinical stabilization and approval for rehabilitation by the responsible surgeon, eligible participants who provide written informed consent will be randomly assigned in a 1:1 ratio to one of two groups: a structured rehabilitation group or a standard postoperative follow-up group. A computer-generated randomization sequence will be prepared by an independent researcher who is not involved in outcome assessment. Allocation concealment will be maintained using sequentially numbered, opaque, sealed envelopes. Because of the nature of the intervention, participants and the treating physiotherapist cannot be blinded. However, outcome assessments will be conducted by a physiotherapist who is blinded to group allocation.

The structured rehabilitation program will be delivered under physiotherapist supervision and supported by a daily home exercise program. The program will include diaphragmatic breathing, thoracic expansion and breathing control exercises, inspiratory muscle training, controlled expiration and coughing techniques, safe swallowing and feeding-position education, individualized oropharyngeal exercises, cervical neutral-position and posture training, scapular stabilization, low-intensity deep cervical flexor activation, pain-free cervical range-of-motion exercises within surgeon-approved limits, upper-extremity mobility and stretching exercises, walking, and gradually increased physical activity.

Inspiratory muscle training will begin at approximately 30% of the participant's baseline maximal inspiratory pressure. Training intensity may be increased according to participant tolerance, perceived exertion, and clinical findings. Swallowing rehabilitation will be individualized according to dysphagia severity. Participants with marked dysphagia, suspected aspiration, or coughing during swallowing will be referred for appropriate specialist assessment. All cervical exercises will comply with the postoperative restrictions established by the surgeon.

Participants assigned to the control group will receive the surgical team's standard postoperative recommendations, including wound care, cervical collar use when indicated, advice regarding daily activities, short-distance walking, and basic permitted movements. They will not receive the structured inspiratory muscle training, swallowing rehabilitation, or supervised cervical-scapular exercise program during the study period. Any additional treatment received outside the study will be documented.

The primary outcome will be swallowing-related symptoms measured using the Eating Assessment Tool-10 (EAT-10). Secondary outcomes will include the Bazaz Dysphagia Grading System, Functional Oral Intake Scale, maximal inspiratory and expiratory pressures, forced vital capacity, forced expiratory volume in one second, FEV1/FVC ratio, peak expiratory flow, Numerical Rating Scale for pain, Neck Disability Index, cervical range of motion, and the 36-Item Short Form Health Survey. Treatment adherence, additional treatments, postoperative complications, and adverse events will also be recorded.

Outcomes will be assessed before the rehabilitation program and during postoperative follow-up. The principal analysis will compare changes over time between the structured rehabilitation and standard follow-up groups. The study will also examine the relationships between changes in dysphagia, respiratory muscle strength, neck function, pain, and health-related quality of life.