Post-Operative Care Following Anterior Cervical Discectomy and Fusion
For optimal recovery after anterior cervical discectomy and fusion (ACDF), patients should follow a structured rehabilitation program that includes early mobilization, appropriate activity restrictions, and physical therapy for range of motion and muscle strengthening.
Immediate Post-Operative Care
- Patients should be monitored for neurological recovery, with most sensory function recovery (85%) occurring within the first year after surgery 1
- Motor function recovery is even more favorable, with 95% of patients recovering within the first year post-ACDF 1
- Most patients can expect to be discharged on postoperative day one 2
- Cryotherapy (ice) may be used in the first few postoperative weeks to manage pain and swelling 3
Cervical Collar Use
- For single-level ACDF, cervical collar use is generally not required by most surgeons (only 20% recommend it) 4
- For multi-level ACDF, cervical collar use is more commonly recommended (70% of surgeons), with an average duration of 9.1 weeks 4
- The decision to use a collar should be based on the stability of the construct and surgeon preference 4
Activity Restrictions
- Lifting restrictions are recommended by 90% of surgeons, with a mean weight limit of 10 kg (approximately 22 pounds) 4
- Driving restrictions are commonly recommended, particularly after multi-level procedures (80% of surgeons) 4
- Most patients return to driving at a median of 16 days after ACDF 2
- Return to work typically occurs at a median of 16 days after ACDF 2
Physical Therapy
- Physical therapy is recommended by 80% of surgeons after both single-level and multi-level ACDF procedures 4
- Despite common recommendation, recent evidence suggests that formal post-operative physical therapy may not significantly improve patient-reported outcomes compared to no formal PT at 6 months and 1 year follow-up 5
- Therapy should focus on range of motion exercises and muscle strengthening 4
- Neuromuscular training is consistently recommended across clinical practice guidelines for spine rehabilitation 3
Follow-Up Care
- Regular follow-up appointments should be scheduled to monitor fusion and neurological recovery
- Only 30% of surgeons routinely obtain a CT scan to confirm fusion at one year 4
- Patients should be monitored for new neurological deficits, as approximately 30% may develop new sensory deficits and 14% may develop new motor deficits during long-term follow-up 1
- Adjacent-level degeneration is a significant contributor to new neurological deficits that develop years after the initial surgery 1
Special Considerations
- For patients with cervical foraminal stenosis, maintaining the height and width of the intervertebral foramen is critical 6
- When placing the intervertebral cage, a relatively posterior position helps preserve the height of the posterior disc space 6
- Bone stimulators are not routinely recommended (only 20% of surgeons recommend them) 4
Expected Outcomes
- Most patients report notable improvement in all patient-reported outcome measures after ACDF 2
- However, approximately 13% of ACDF patients may report worsening of symptoms 2
- The revision surgery rate is approximately 2.2% for ACDF procedures 2
- In-hospital complication rates are around 13% (8% minor and 5% major) 2
Treatment of Mild Cervical Spondylotic Myelopathy
- For mild cervical spondylotic myelopathy (modified Japanese Orthopaedic Association [mJOA] scale scores > 12), either surgical decompression or nonoperative therapy can be effective in the short term (3 years) 3
- Nonoperative therapy may include prolonged immobilization in a stiff cervical collar, "low-risk" activity modification or bed rest, and anti-inflammatory medications 3
- More severe cervical spondylotic myelopathy (mJOA scale score ≤ 12) should be treated with surgical decompression, with benefits maintained for at least 5 years and up to 15 years postoperatively 3