Incidence of complications associated with cervical spine surgery and post-operative physical therapy and implications for timing of initiation of post-operative physical therapy: a retrospective database study

Justin M Lantz; Callie Roberts; Blake Formanek; Lori A Michener; Raymond J Hah; Jeffrey C Wang; Zorica Buser

doi:10.1007/s00586-022-07466-7

Incidence of complications associated with cervical spine surgery and post-operative physical therapy and implications for timing of initiation of post-operative physical therapy: a retrospective database study

Eur Spine J. 2023 Jan;32(1):382-388. doi: 10.1007/s00586-022-07466-7. Epub 2022 Nov 19.

Authors

Justin M Lantz^{1

2}, Callie Roberts³, Blake Formanek⁴, Lori A Michener³, Raymond J Hah⁴, Jeffrey C Wang⁴, Zorica Buser⁴

Affiliations

¹ Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1640 Marengo St, HRA 102, Los Angeles, CA, 90033, USA. lantzj@pt.usc.edu.
² USC Spine Physical Therapy Fellowship Program, University of Southern California, Los Angeles, CA, USA. lantzj@pt.usc.edu.
³ Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1640 Marengo St, HRA 102, Los Angeles, CA, 90033, USA.
⁴ Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA.

PMID: 36401668
DOI: 10.1007/s00586-022-07466-7

Abstract

Purpose: To describe the incidence of complications associated with cervical spine surgery and post-operative physical therapy (PT), and to identify if the timing of initiation of post-operative PT impacts the incidence rates.

Methods: MOrtho PearlDiver database was queried using billing codes to identify patients who had undergone Anterior Cervical Discectomy and Fusion (ACDF), Posterior Cervical Fusion (PCF), or Cervical Foraminotomy and post-operative PT from 2010-2019. For each surgical procedure, patients were divided into three 12-week increments for post-operative PT (starting at post-operative weeks 2, 8, 12) and then matched based upon age, gender, and Charlson Comorbidity Index score. Each group was queried to determine complication rates and chi-square analysis with adjusted odds ratios, 95% confidence intervals, and p-values were used.

Results: Following matching, 3,609 patients who underwent cervical spine surgery at one or more levels and had post-operative PT (ACDF:1784, PCF:1593, and cervical foraminotomy:232). The most frequent complications were new onset cervicalgia (2-14 weeks, 8-20 weeks, 12-24 weeks): ACDF (15.0%, 14.0%, 13.0%), PCF (18.8%, 18.0%, 19.9%), cervical foraminotomy (16.8%, 16.4%, 19.4%); revision: ADCF (7.9%, 8.2%, 7.4%), PCF (9.3%, 10.6%, 10.2%), cervical foraminotomy (11.6%, 10.8% and 13.4%); wound infection: ACDF (3.3%, 3.4%, 3.1%), PCF (8.3%, 8.0%,7.7%), cervical foraminotomy (5.2%, 6.5%, < 4.7%). None of the comparisons were statistically significant.

Conclusion: The most common post-operative complications included new onset cervicalgia, revision and wound infection. Complications rates were not impacted by the timing of initiation of PT whether at 2, 8, or 12 weeks post-operatively.

Keywords: Cervical spine; Complications; Physical therapy; Post-operative; Post-surgical; Spine surgery.

MeSH terms

Cervical Vertebrae / surgery
Diskectomy / adverse effects
Diskectomy / methods
Foraminotomy* / methods
Humans
Incidence
Neck Pain / surgery
Physical Therapy Modalities
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Radiculopathy* / surgery
Retrospective Studies
Spinal Fusion* / adverse effects
Spinal Fusion* / methods
Treatment Outcome
Wound Infection* / complications
Wound Infection* / surgery