# data[].attributes.body
o   Incision to expose disc

o   Removal of disc material

o   Decompression of nerve roots

o   Bone dowel packed into disc space

# data[].attributes.body
1. Bone graft is used to stabilize one or more vertebrae in the cervical spine and held in place with screws, rods, and wires to prevent movement of the vertebrae and hold the graft in place. This procedure is used to treat cervical fractures, instability, severe kyphosis or degenerative disc disease

2. More common for spinal cord compression due to spinal stenosis

# data[].attributes.body
o   No driving while on narcotics

o   NSAIDs are okay 6 months after surgery

o   may or may not use C-Collar

o   Initiate PT 4-6 weeks status-post surgery

o   No scar mobilization until closure (approximately 6-8 weeks)

o   Sedentary occupation- return 4-6 weeks post-op

o   Heavy labor occupation- restricted activity between 4-16 weeks post-op

o   May initiate jogging/running after 6 months

o   Avoid bending and twisting of the neck and back after surgery until cleared by surgeon, do not lift more than 10 lbs

# data[].attributes.body
o   Excessive swelling

o   Trouble breathing

o   Chest pain

o   Bleeding and wound drainage that does not slow down or stop with a new dressing

o   New onset of weakness, numbness, and tingling

# data[].attributes.body
o   Neck Disability Index (NDI)

o   VAS

o   SF-36

o   PROMIS

# data[].attributes.body
1. Overall Precautions:

1. Avoid cervical flexion

2. Promote AROM and avoid passive stretching

3. Limit cervical ROM until 8-10 weeks

# data[].attributes.headline
Rehabilitation Phases with specific exercises and recommended dosages:

# data[].attributes.subject
Rehabilitation Phases with specific exercises and recommended dosages:

# data[].attributes.body
o   Phase 1:

Supported chin tuck, cervical AROM within pain free range, isometrics (flexion, rotation, side bend), stretch pectoralis and upper thoracic spine, scapular retractions in sitting and standing, arm “W” supported arm slides on bed, stationary bike or walking 2x/day for 10-20 minutes

o   Phase 2:

Prone scapular retractions, rows w/ resistance band, shoulder extension, horizontal abduction, lat pulldowns, pallof press, UBE, walking 30 min/day, cervical retraction, neck rotation, bicep curls, tricep extension, shoulder IR/ER

o   Phase 3:

Aerobic conditioning, shoulder shrugs, bending and lifting weighted items, postural stability, core exercises

o   Phase 4:

Begin overhead activities, increase weights by 5 lbs every other week, begin elliptical training, independent with HEP

o   Phase 5:

Return to work

# data[].attributes.body
o   Phase 1: (1-6 weeks post-op)

Wound healing (protection)

ADLs

Sitting <30 minutes at a time

Appropriate sitting posture

Walking program (30 minutes per day)

Assistive device

o   Phase 2: (4-6 weeks post – op)

Pain control

Wound healing

Improve endurance

Upright tolerance

Position changes every 30 minutes

Reestablish the neuromuscular control of cervical and cervical and scapulothoracic muscle stabilizer

o   Phase 3:

Achieve functional shoulder AROM (avoid overhead reaching for 8 weeks)

Demonstrate proper posture and ergonomics and work simulation

@ 3 months gentle cervical

o   Phase 4: (3-6 months)

Proper sitting/standing posture

Minimal to no pain with all or most activities

Return to work/PLOF

Cervical and shoulder AROM WNL

Independent with HEP

o   Phase 5:

Return to work

# data[].attributes.body
1. Yellow flags

1. Fear-avoidance behaviors (scared/hesistant to move)

2. Depression/anxiety

2. Red Flags

1. Signs of infection

1. Fever, chills, malaise, shortness of breath, excessive drainage, redness, or extreme pain and tenderness in calf region

2. Neuro changes

1. Changes in bowel or bladder function, numbness, loss of sensation.

2. Some weakness and fatigue is normal, but excessive needs medical attention

# data[].attributes.body
1. Neck Disability Index (NDI): assess a patient’s neck pain and how it affects their daily activities

2. Visual analog pain scale: assess a patient’s pain

# data[].attributes.body
https://medicine.osu.edu/-/media/files/wexnermedical/patient-care/healthcare-services/neurological-institute/departments-and-centers/clinical-centers/spine-care/protocols/anterior-acdf-2021.pdf?la=en&hash=EA7EE91798E5590EAFB25894A0DB52DAF3050277#:~:text=%2D%20Lifting%20%3E20%20lbs%20up%20to,horseback%20riding%20for%206%20months

# data[].attributes.body
Phase 1 (0-8 weeks)

1. Protect the tissue by preventing excessive initial mobility

2. Limit BLT

3. Follow physician recommendations on the use of collar

1. Education on bed mobility and transfers with proper spine positioning.

2. Reinforce basic post-op home exercise program including a. Diaphragmatic breathing b. Relaxation exercises c. Upper extremity extension isometric exercises

3. Increase tolerance to walking (½ mile daily) or bike (15-30 min cardiovascular activity) 4. Reinforce sitting, standing and ADL modifications with neutral spine and proper body mechanics.

Phase 2 (8-12 weeks)

Body mechanics-Functional activity performance, proper positioning

Manuel therapy- Grade 1 and 2, scar mobilization, nerve mobilization

Exercise- posture, breathing, ROM, cardiovascular training

Phase III: Advanced PT 12-18 weeks/2-3 times per week Goals:

1. Progress with strengthening and flexibility exercises. 2. Advanced lifting and posture training 3. Initiate balance activities 4. Address return to work/recreational activity concerns 5. Advanced stabilization and trunk control

# data[].attributes.body
1. Acute → Subacute

1. Pain/swelling within tolerance

2. Independent with HEP/self-care

3. Tolerance of 15-30 minutes of exercise

2. Sub-acute → Advanced

1. Good body mechanics when lifting

2. Hold chin tuck for 10 seconds

3. Tolerate 30 minutes of cardio

4. Tolerate 45-60 minutes of dynamic sitting/standing

3. Discharge

1. MMT and ROM WNL

2. Independent with HEP

# data[].attributes.body
1. 2-3 weeks can return to light desk jobs

2. 6-12 weeks to return to heavier manual labor jobs

# data[].attributes.body
small incision is made to the neck, the damaged disc is then removed

End plates are prepared to accept new artificial disc

An artificial disc is then implanted

An artificial disc preserves motion due to the polymer surface

# data[].attributes.body
-no driving while on narcotics

-no tobacco

-C-Collar per surgeon

-NSAIDS are okay for pain and inflammation at 2 weeks

-no Bending lifting or twisting

-Summary: minimize strain on surgical site

# data[].attributes.body
Signs of an infection: fever, chills, general malaise

Excessive drainage

DVT: redness, heat, tenderness, or pain in the calf region

# data[].attributes.body
Cervical AROM (refrain from measuring extension and rotation AROM until 6 weeks post-op

Shoulder AROM

Posture: Wall to occiput measurement or tragus to wall measurement

Walking duration

Walking distance

SF-36: Short form health survey

Visual analogue scale for pain

# data[].attributes.headline
Rehabilitation Phases with specific exercises and recommended dosages

# data[].attributes.subject
Rehabilitation Phases with specific exercises and recommended dosages

# data[].attributes.body
Phase 1 (POD 1 - 3 weeks post-op)

Walking program (goal 30 minutes twice per day)

Performing ADLs correctly

- Don/doff shoes, correctly picking items off ground, etc

Postural Exercises

Phase 2 (3-6 weeks post-op) - PT program (2-3x/week) for recommended 6-8 weeks

aerobic conditioning

UBE no resistance/treadmill/recumbent bike

Cervical/Upper Extremity/Core conditioning

Cervical retractions

Scapular retractions

shoulder shrugs

scapular clocks

Biceps/triceps/shoulder ER/IR/Flex/EXT

Flexibility, mobility

STM to paraspinal muscles

Light/gentle cervical AROM with neutral spine

Phase 3 (6 weeks - 3 months post-op)

Aerobic conditioning

UBE, treadmill, upright/recumbent bicycle

Muscle conditioning of cervical and scapulothoracic spine

Cervical isometrics in neutral

mid back rows, lat pull downs, high rows, PNF D1/D2 pattern, shoulder ER/IR, shoulder ADD/ABD

Dynamic core co-contraction conditioning (2-3x x 10 → 15 → 20)

Hook-lying pelvic neutral (hip at 90°): marches → SL heel slide → leg lift c knee ext, dead bugs

Bridges with postural cueing

Quadruped isometric, unilateral shoulder flexion, bird dogs

LE strengthening with neutral spine (progress with resistance band, 2-3x 10 → 15 → 20)

Stability ball wall squats

Standing hip abduction

Lunges (forward, lateral, posterior)

Phase 4 (3+ months post-op)

Trunk and LE strengthening - 2-4x 10 → 15 → 20

Stabilization exercises

Bridges

Planks (5-30 sec)

Prone and side-lying planks (5-30 sec)

Loaded carries (farmers walks, 90/90 bottoms up, kettle-bell carries) (15 sec - 1 min)

Paloff Press

Work related activities

# data[].attributes.body
Phase 1:

Wound healing (<5- 8 lb lifting limit, NSAIDs are okay) - Performing ADLs correctly

Don/doff shoes, correctly picking items off ground, etc

Sitting no greater than 30 minutes at a time

Appropriate sitting posture- suggest using a lumbar roll and cervical/thoracic retracted positioning

Walking program (goal 30 minutes twice per day) - Correct usage of assistive device as indicated

Phase 2:

Pain control (modalities, manual therapy soft tissue mobilization as needed)

Wound healing (<5-8 lb lifting limit, increasing 5# every other week)

Begin gentle overhead reaching no sooner than 4 weeks

Maintain erect posture throughout the day

Reestablish neuromuscular control of cervical and scapulothoracic muscle stabilizers -

Improve UE and cervical mobility, wean collar usage

Progress toward discontinuing assistive devices - Initiate aerobic conditioning

Encourage movement

Phase 3:

Return to baseline standing/walking duration and distance

Achieve functional cervical/shoulder AROM

Improve UE/cervical strength (<20 lbs through 8 weeks)

Demonstrate proper posture, ergonomics and work simulation

Continue progressive walking program

Independent with HEP

Phase 4:

Proper sitting/standing posture

Minimal to no pain with all or most activities

Return to work/prior level of function or greater

Within normal limits of cervical AROM and shoulder AROM

Independent with home exercise program

Achieve MCID on the Neck Disability Index outcome measure questionnaire

# data[].attributes.body
Sedentary to light work (<10lbs):

Full duty: 1-6wks

Moderate (frequently 20 lbs occasional 50 lbs):

Restrictive duty (10lbs): 1-6wks

Restrictive duty (<40lbs): 8-12wks

Moderate to full duty: 12-14+ wks

Moderate (frequently 50 lbs occasional 100 lbs):

Restrictive duty (10lbs): 1-8wks

Restrictive duty (<40lbs): 8-12wks

Moderate to full duty: 12-14+ wks