Ling Jeremiah, Thirumavalavan Jeyvikram, Shin Caleb, Lee Tiffany M, Marco Rex A W, Hirase Takashi
Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA.
Cureus. 2023 May 16;15(5):e39081. doi: 10.7759/cureus.39081. eCollection 2023 May.
Postoperative rehabilitation has recently been identified as a high-priority research topic for improving surgical outcomes for degenerative cervical spondylosis (DCS). However, there remains no consensus on specific rehabilitation strategies. Thus, the objective of this study was to evaluate the effectiveness of postoperative rehabilitation strategies for short-term and long-term outcomes after cervical spine fusion for DCS. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines using the PubMed, Scopus, and Ovid Medline databases. All level I-IV therapeutic studies in the English language investigating the outcomes of postoperative rehabilitation strategies after cervical spine fusion for DCS were included. Nine studies with 895 patients with DCS (747 anterior-only fusion, 55 patients with posterior-only fusion, 93 patients with physiotherapy alone) were included in this analysis, with 446 (49.8%) patients receiving physiotherapy alone or standard postoperative therapy and 449 (50.2%) patients receiving standard postoperative therapy with additional intervention or augmentation. These interventions included pulsed electromagnetic field (PEMF) stimulation, telephone-supported home exercise program (HEP), early cervical spine stabilizer training, structured postoperative therapy, and a postoperative cervical collar. One level II study demonstrated that PEMF led to increased fusion rates at six months postoperatively compared to standard therapy alone, one level II study demonstrated that postoperative cervical therapy in addition to standard therapy was better than standard therapy alone in the improvement of neck pain intensity, one level IV study demonstrated home exercise therapy led to an improvement in neck pain, arm pain, and disability, and six level II studies reported no difference in clinical outcome measures between augmented or targeted therapy and standard postoperative therapy for DCS. In conclusion, there is moderate evidence to suggest that there is no significant difference in clinical and surgical outcomes between standard postoperative therapy and augmented or targeted postoperative therapy for cervical fusion in the setting of cervical spondylosis. However, there is some evidence to support that certain therapeutic modalities, such as PEMF stimulation, may lead to improved fusion rates, clinical outcomes, and patient satisfaction when compared to standard postoperative therapy protocols. There is no evidence to support a difference in effectiveness with different types of postoperative rehabilitation strategies between anterior and posterior fusions for DCS.
术后康复最近被确定为改善退行性颈椎病（DCS）手术效果的一个高度优先研究课题。然而，对于具体的康复策略仍未达成共识。因此，本研究的目的是评估术后康复策略对DCS颈椎融合术后短期和长期结果的有效性。根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、Scopus和Ovid Medline数据库进行了系统评价。纳入所有以英文发表的I-IV级治疗性研究，这些研究调查了DCS颈椎融合术后康复策略的结果。本分析纳入了9项研究，共895例DCS患者（747例仅行前路融合，55例仅行后路融合，93例仅接受物理治疗），其中446例（49.8%）患者仅接受物理治疗或标准术后治疗，449例（50.2%）患者接受标准术后治疗并附加干预或强化治疗。这些干预措施包括脉冲电磁场（PEMF）刺激、电话支持的家庭锻炼计划（HEP）、早期颈椎稳定器训练、结构化术后治疗以及术后颈托。一项II级研究表明，与单纯标准治疗相比，PEMF可使术后6个月的融合率提高；一项II级研究表明，除标准治疗外的术后颈椎治疗在改善颈部疼痛强度方面优于单纯标准治疗；一项IV级研究表明，家庭锻炼疗法可改善颈部疼痛、手臂疼痛和功能障碍；六项II级研究报告称，对于DCS，强化或靶向治疗与标准术后治疗在临床结局指标上无差异。总之，有中等证据表明，在颈椎病背景下，标准术后治疗与强化或靶向术后颈椎融合治疗在临床和手术结果上无显著差异。然而，有一些证据支持，与标准术后治疗方案相比，某些治疗方式，如PEMF刺激，可能会提高融合率、改善临床结果并提高患者满意度。没有证据支持DCS前路和后路融合在不同类型术后康复策略的有效性上存在差异。
