From the Research
Gait instability often improves after anterior cervical discectomy and fusion (ACDF) for cervical spinal stenosis, with significant improvement in walking ability and balance within 3-6 months post-operation. Patients with cervical stenosis frequently experience gait problems due to spinal cord compression, which disrupts normal neurological signals to the lower extremities. Following ACDF surgery, many patients report significant improvement in their walking ability and balance, though the timeline varies based on the severity and duration of preoperative symptoms. The improvement occurs because decompression of the spinal cord allows for better neurological function and reduced myelopathy symptoms. However, the degree of improvement depends on several factors including the duration of symptoms before surgery, age, presence of comorbidities, and extent of preoperative spinal cord damage. Patients with shorter duration of symptoms and less severe cord compression typically experience better outcomes. Postoperative physical therapy focusing on gait training and balance exercises is essential to maximize recovery, typically starting 4-6 weeks after surgery and continuing for 3-6 months. Some patients may experience immediate improvement, while others may see gradual progress over several months as the spinal cord heals from the previous compression. According to a study published in 2003 1, a case report demonstrated the role of biomechanics in characterizing impairments associated with cervical spondylosis and its surgical intervention, with measures for spasticity, strength, and gait taken before and after surgery indicating a favorable outcome. Another study published in 2021 2 reviewed the anatomy of the spine and treatment options for cervical disc disease, presenting an in-depth review of the ACDF procedure, including the expected perioperative course and care considerations.
Key Factors Influencing Outcome
- Duration of symptoms before surgery
- Age
- Presence of comorbidities
- Extent of preoperative spinal cord damage
- Postoperative physical therapy
Recommended Postoperative Care
- Postoperative physical therapy focusing on gait training and balance exercises, typically starting 4-6 weeks after surgery and continuing for 3-6 months
- Monitoring for potential complications, such as infection, spinal fluid leakage, or postoperative hematoma
- Follow-up appointments to assess progress and adjust treatment plan as needed
Relevant Studies
- A study published in 2004 3 found that myelocompression, but not adjacent instability, affects patient-reported quality of life and cervical spine symptoms after ACDF
- A study published in 2002 4 reported a fusion rate of 86.6% and rates of permanent hoarseness of 3.4%, dysphagia of 0.7%, and an instrumentation failure rate of 5.4% after cervical corpectomy with fibular allograft reconstruction and anterior plating
- A study published in 2019 5 identified independent prognostic factors for discharge disposition in patients undergoing ACDF, including older age, marital status, Medicare insurance, Medicaid insurance, previous spine surgery, myelopathy, preoperative comorbidities, anemia, and leukocytosis.