Rehabilitation following cervical spine fusion helps to restore functioning of the neck and the upper extremities following surgery.
In this article, we shall point out who needs cervical spine fusion, discuss the types of cervical spine fusion and the rehabilitation following cervical spine fusion surgery.
Cervical spine fusion surgery is commonly done for degenerative spine conditions and conditions associated with nerve impingement to relieve patients of incessant pain.
What is cervical fusion
Cervical spine fusion is a major spine surgery that involves the surgical joining of different spine levels so that segment becomes one. For example, if the joint of cervical spine five (C5) is fused to that of cervical spine level 6 (c6).
Therefore that joined part starts to act as one single segment.
Who needs it
There are two main indications for spine surgery which are;
- Mechanical instability. Simply put, if there is a problem in the supporting structure of the spine that disrupts the way weight is transmitted through the back that is mechanical instability. This can present as pain, or deformity of the back in this case the neck.
- Neurological instability. Neurological instability means that there is a compromise in the way neurological messages are transmitted from the spinal cord to the end organs which in this case are the hands (or upper limbs in general.)
You may need cervical spine surgery if you have the following conditions;
- Cervical myelopathy
- Cervical stenosis
- Degenerative cervical spine disease
- Herniated disc
- Spondylolisthesis of the cervical spine
- Congenital spine disorders
Types of cervical fusion
The terms given to the kind of cervical spine fusion surgery mostly depend on the position where the incision is made to access the neck.
- Anterior cervical spine fusion.
In this case the cervical spine is accesses from the front. Most common fusion surgery is the anterior cervical discectomy and fusion (ACDF).
- Posterior cervical spine fusion
In posterior fusion, the cervical spine is accessed from the back. This has a couple of more options which are interspinous wiring with bone grafting, lateral mass, plating, and screw fixation.
What you should not do after cervical spine fusion
- No twisting your neck to look behind. Turn the whole body instead!
- No excessive flexion of your neck; meaning that you are not allowed to move your chin to the chest.
General information about physiotherapy after cervical spine fusion.
Immediate physiotherapy
While still in the hospital or in the first few days after discharge, the following activities can be done through consult with your doctor first to give you the go-ahead.
- The rehabilitation you will have will depend on the kind of condition that prompted the surgery.
- Gentle exercises following the surgery are acceptable these include; walking with the aid of a cane.
- Calf pumping exercises as enable blood to enter and exit the calf reducing the risk of deep venous thrombosis.
When to start the rehabilitation protocol
It is often started at about 6 weeks to 3 months following surgery
Range of motion exercises
These help improve flexibility.
- Resisted flexion
You can do this either seated or standing. Stay upright and look ahead.
Place the palm of your hand on your forehead and attempt to push your head forward. You will feel the tension in your neck muscles.
Count to ten and take a break. Do this 3 times.
- Resisted extension
You can do this in either seated or standing. Stay upright and look ahead.
Place the palm of your hand on the back of your head and attempt to push your head backward. You will feel the tension in your neck muscles.
Count to ten and take a break. Do this 3 times.
- Resisted side bend
Just like the above exercises, you can do this either seated or standing. Stay upright and look ahead.
Place the palm of your hand on the side of your head; you can start with either side.
Attempt to push your head on the opposite. You will feel the tension in your neck muscles.
Count to ten and take a break. Do this 3 times.
Repeat these exercises about three to four times a day.
Body conditioning exercises
Aerobic exercises plus cardio exercises are great for conditioning the body. These exercises are good for the mental aspect too. These include;
- Walking outside or on a treadmill,
- Swimming
- Light jogging.
- The use of some exercise equipment like the elliptical machine and the stair climber all help build endurance and keep your heart healthy.
Neck strengthening exercises
Resistance training with light weights improves strength and stability in the body, and especially the neck.
Does the number of levels fused affect the physiotherapy I have?
The more levels fused, the less motion you may have in your neck! But some exercises still stay. You will need to do range of motion exercises for the joints that are still mobile and strengthen the adjacent neck muscles.
Returning to sports following cervical fusion surgery
Most elite athletes are able to return to sports following cervical spine fusion. Aside from the clinical status and general well-being, a radiological assessment also needs to be done to assess for bone healing prior to returning to sports.
In addition, a strict physiotherapy protocol needs to be adhered to in order to recover muscle strength and proper coordination. It is important to get permission from your surgeon before returning to sports.
How to sleep after cervical spine fusion
- Sleep with the collar on. The collar provides external support to the neck while preventing exaggerated movements in the course of the healing.
- Elevate the head of your bed to approximately 30 degrees as this reduces the swelling through gravity.
- You are allowed to sleep either on your back or on your tummy.
In conclusion, life after cervical spine fusion is a true adjustment but it’s all manageable. The rehabilitation following cervical spine fusion will involve range of motion exercises and body conditioning exercises. Consult with your doctor first before you start any exercise regimen.
