Post-Operative Conservative Management After Total Disc Arthroplasty
Conservative management with medications and physical therapy is medically indicated and represents standard post-operative care for this patient following C6-C7 total disc arthroplasty for cervical radiculopathy. 1
Post-Operative Rehabilitation Protocol
Physical therapy is a critical component of post-operative recovery following cervical disc arthroplasty, with demonstrated statistically significant clinical improvement in patients with cervical radiculopathy. 1 The integration of structured physical therapy after surgical intervention optimizes functional outcomes and facilitates return to full activity. 2
Timeline for Conservative Management
Immediate post-operative period (0-6 weeks): Physical therapy should be initiated to restore range of motion and prevent deconditioning, as prolonged immobilization leads to rapid bone loss (1% per week) and muscle strength loss (15% in just 10 days). 3
Intermediate recovery (6 weeks to 3 months): Continued physical therapy achieves comparable clinical improvements to surgical interventions alone at 12 months, though surgical decompression provides more rapid relief within 3-4 months. 1, 4
Long-term maintenance (3-12 months): Physical therapy maintains motor function improvements, including wrist extension, elbow extension, and shoulder abduction gains achieved through surgical decompression. 1
Medication Management Post-Operatively
Appropriate analgesic management is medically necessary to control post-operative pain and facilitate participation in physical therapy. 3 However, the goal should be progressive reduction in narcotic usage:
At 24 months post-operatively, 89.9% of cervical disc arthroplasty patients should not require strong narcotics or muscle relaxants. 5
Conservative pain management reduces the vicious cycle of physical deconditioning that occurs with prolonged narcotic use and bed rest. 3
Clinical Outcomes Supporting Conservative Management
Cervical disc arthroplasty demonstrates high success rates when combined with appropriate post-operative conservative care:
Relief of pre-operative symptoms occurs in 88.7% of patients following cervical disc arthroplasty. 2
Return to full pre-operative activity is achieved in 92.2% of patients. 2
Neurologic success (improvement or maintenance) is achieved in 90.9% of patients at 24 months. 5
The procedure maintains 84.4% of patients with ≥4 degrees of motion at the operated level at 24 months. 5
Critical Considerations for This Patient
The CPT codes listed (95938,95941,95870,95937) represent electrodiagnostic studies that may be used for post-operative assessment of nerve function recovery, not the arthroplasty procedure itself. These studies can document objective improvement in radiculopathy following surgical intervention. 3
Physical therapy must be integrated once acute post-operative pain is controlled to prevent the complications of immobilization including decubitus ulcers, deep venous thrombosis, and accelerated bone loss. 3, 4
The patient should be monitored for adjacent segment disease, which occurs at approximately 3% per year following cervical procedures, though disc arthroplasty theoretically reduces this risk compared to fusion. 6
Common Pitfalls to Avoid
Premature discontinuation of physical therapy: The 90% success rate with conservative management requires adequate duration of therapy to achieve maximal benefit. 1, 4
Excessive reliance on narcotics: Prolonged narcotic use leads to physical deconditioning and increased risk of additional complications. 3
Failure to document therapy response: Objective outcome measures including neck disability index (NDI), visual analog scale (VAS) pain scores, and SF-36 scores should be tracked to document improvement. 5