o   Removal of disc material

o   Decompression of nerve roots

o   Bone dowel packed into disc space

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

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

o   VAS

o   SF-36

o   PROMIS

• 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

• 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

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

• 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

-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

• Signs of an infection: fever, chills, general malaise

• Excessive drainage 

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

• 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

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

• 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

• 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