What complications arise from heavy lifting after anterior cervical discectomy and fusion (ACDF)?

From the Guidelines

Heavy lifting after anterior cervical discectomy should be avoided to prevent serious complications, including disruption of the surgical site, instability of the cervical spine, and damage to the spinal cord or nerve roots. The recovery period after anterior cervical discectomy is crucial, and patients should typically avoid lifting anything heavier than 5-10 pounds for at least 4-6 weeks following surgery, with gradual return to normal activities only after clearance from their surgeon 1.

Some of the main problems that can result from premature heavy lifting include:

• Disruption of the surgical site, which may cause the fusion to fail or the implanted hardware to shift or break
• Instability of the cervical spine, potentially damaging the spinal cord or nerve roots
• Increased intradiscal pressure and significant strain on the neck muscles and surgical area, which can cause pain, inflammation, and delayed healing
• Risk of graft dislodgement if bone grafts were used during the procedure

Patients may experience worsening neck pain, new-onset arm pain or neurological symptoms like numbness, tingling, or weakness if complications occur 1. Most experts advise patients to avoid future activities that may lead to neck injury, extreme straining, or excessive force and motion on the neck, including contact sports, activities causing hyperextension of the neck, weight lifting, labor related to childbirth, other strenuous exercises, and chiropractic manipulation of the neck region 1.

The healing process after cervical fusion typically takes 3-6 months for the bone to fully fuse, and premature heavy lifting can compromise this process, potentially necessitating revision surgery. It is essential for patients to follow their surgeon's instructions and avoid heavy lifting to ensure a smooth and successful recovery.

From the Research

Problems Resulting from Heavy Lifting after Anterior Cervical Discectomy

• Heavy lifting after anterior cervical discectomy and fusion (ACDF) can lead to various complications, including:
  • Increased risk of implant failure or graft displacement 2
  • Exacerbation of existing cervical spine conditions, such as herniated discs or spinal stenosis 3
  • Potential for new injuries or conditions, including muscle strains or ligament sprains 2
• The study by 2 found that 90% of surgeons recommend lifting restrictions after ACDF, with a mean lifting limit of 10 kg, to minimize the risk of complications.
• However, there is limited scientific evidence on the specific restrictions and guidelines for patients after ACDF, and more research is needed to determine the optimal postoperative care and rehabilitation protocols 2.
• Other studies have focused on the risks and benefits of ACDF, including the potential for chronic opioid use 4, and the effectiveness of opioid-free analgesia in managing postoperative pain 5.
• Additionally, research has shown that older adults may be at increased risk for complications after ACDF, including respiratory and central nervous system complications, and death 6.
• It is essential to follow the recommended postoperative guidelines and lifting restrictions to ensure a safe and successful recovery after ACDF.