What are the activity limitations and post-operative instructions for a patient after Anterior Cervical Discectomy and Fusion (ACDF) surgery?

Activity Limitations Post-Operative ACDF Surgery

Patients should avoid lifting more than 10 kg (approximately 22 pounds) following ACDF surgery, with 90% of spine surgeons agreeing on this restriction, and 80% recommending physical therapy for range of motion and muscle strengthening. 1

Cervical Collar Use

• Single-level ACDF: Only 20% of surgeons recommend cervical collar use after single-level procedures 1
• Multilevel ACDF: 70% of surgeons recommend cervical collar use for an average of 9.1 weeks (±2.8 weeks) following multilevel procedures 1

Weight and Lifting Restrictions

• Lifting limit: 10 kg (22 pounds) is the consensus restriction, with 90% of surgeons providing this guidance for both single-level and multilevel ACDF 1
• This restriction helps protect the fusion construct during the critical healing period and reduces risk of pseudarthrosis 2

Driving Restrictions

• Single-level ACDF: 50% of surgeons restrict driving temporarily 1
• Multilevel ACDF: 80% of surgeons restrict driving 1
• Evidence shows that return to driving occurs faster with plated ACDF compared to non-plated procedures (p < 0.05) 2, 3

Physical Therapy and Rehabilitation

• 80% of surgeons recommend physical therapy for range of motion and muscle strengthening after both single-level and multilevel ACDF 1
• Physical therapy should focus on progressive mobilization rather than immobilization, as immediate mobilization improves outcomes 4
• Patients can expect significant improvements in physical function, social function, and bodily pain following ACDF 3

Return to Work

• Return to work occurs faster with plated ACDF compared to non-plated procedures (p < 0.05) 2, 3
• The American Association of Neurological Surgeons reports good to excellent outcomes in approximately 90% of properly selected patients 3

Expected Range of Motion Loss

• Multilevel ACDF (3-4 levels) results in significant ROM reduction: 5
  • Flexion: 39.5% reduction 5
  • Lateral flexion: 25.7-25.9% reduction 5
  • Extension: 18.3% reduction 5
  • Rotation: 14.0-14.4% reduction 5
• Despite these losses, patients typically do not experience great difficulties performing daily activities 5

Neurologic Recovery Timeline

• Sensory recovery: 85% of patients recover sensory function within 1 year 6
• Motor recovery: 95% of patients recover motor function within 1 year 6
• The first year post-operatively is the critical period for neurologic recovery 6

Common Pitfalls to Avoid

• Avoid excessive focus on cervical lordosis restoration at the expense of maintaining intervertebral foramen height and width, which is more critical for patients with foraminal stenosis 7
• Monitor for adjacent segment degeneration: 30% of patients develop new sensory deficits at adjacent levels, and 76% of new motor deficits occur at adjacent levels 6
• Do not routinely immobilize: Immediate mobilization is preferred over prolonged immobilization, as it does not compromise fusion and improves functional recovery 4

Follow-Up Imaging

• CT is the most sensitive modality to assess fusion status, altering treatment plans in 39% of patients with persistent symptoms 3
• 30% of surgeons obtain CT at one year to confirm fusion 1
• MRI is most sensitive for soft-tissue abnormalities but may be limited by metal artifact 3

Bone Stimulator Use

• Only 20% of surgeons recommend bone stimulator use, indicating this is not standard practice 1
• Fusion rates with anterior plating are significantly higher (94% overall vs 88% without plating), with more pronounced differences in 2-level procedures (91% vs 72%) 3