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Aaron WeyMD, FAAOS, FACSAdult and Pediatric Spine Surgery
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Spine · Post-op rehabilitation protocol

Cervical Fusion or Arthroplasty

After cervical fusion or disc replacement: a month of rest, neck motion and posture work, strengthening from month one, full activity at six months.

This is the rehabilitation plan I ask your physical therapist to follow after this operation. Bring it to your first therapy visit. It is a framework, not a prescription: your therapist adjusts the pace to how you are healing, and anything we discussed in the office takes precedence over what is printed here. If something on this page does not match what we talked about, ask me.

Physical therapist: please send progress notes to the office at (201) 836-1663 and call with any question about the plan.

Days 1–30

Exercises

  • Usually not referred to PT until after the first 30 days of recovery at home
  • C-collar – Per surgeon, wear at night for comfort
  • Sit in chair for all meals
  • Sit at 30+ minute intervals throughout the day
  • Posture education – Use lumbar roll when sitting
  • Pelvic tilts
  • Spinal stabilization ex – in supine, neck supported (no bridging)
  • Upper extremity active motion (AROM) to tolerance
  • Deep breathing exercises
  • Cervical AROM in pain-free range – No PROM (NO Stretching)
  • Gentle 2-finger isometrics
  • Scapular retraction, shoulder shrugs, chin tucks
  • Stationary bike
  • Treadmill – Walking progression program as tolerated
  • Lifting to tolerance with proper body mechanics – Pain free
  • Ice as needed

Goals

  • Pain control
  • Independent ambulation, mobility and ADLs

Months 1–3

Exercises

  • Continue appropriate previous exercises
  • Upper extremity Theraband x 6
  • Scapular retraction exercises with Theraband
  • Biceps / triceps strengthening with light weight
  • UBE
  • Elliptical trainer
  • Upper trap / postural stretches
  • Ergonomics education
  • TENS and ice to assist with pain relief prn

Goals

  • Full AROM C-spine
  • Able to lift 20 lbs with ease

Months 3–6

Exercises

  • Weight training (UE & LE) as tolerated
    • No overhead resistance exercises
  • Work hardening / job-specific exercises
  • Theraband PNF with lumbar stabilization principles
  • Push-up progression
  • Sit-up progression
  • Treadmill – Running progression program

Goals if fused, pain-free and reconditioned

  • Pass a return-to-sport / fitness test at 6 months post-op
  • Resume all activities at 6 months post-op

Months 6+

Exercises

  • Functional training exercises for sports or work specific activities
  • Progressive weight training
  • High impact / aerobic activity
  • May begin carrying heavy gear and loads (e.g. body armor, a loaded pack)
  • May begin contact sports

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "Cervical Fusion WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: Cervical Fusion WB08.pdf. Army-specific wording in the original (Con Leave, MOS, APFT, Kevlar, rifle) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.