Post-Surgical Rehabilitation Therapy Is Independently Associated With Improved Outcomes After Surgery For Degenerative Cervical Myelopathy

Introduction: Despite widespread use, there is limited evidence to support the use of post-surgical rehabilitation to enhance neurological recovery after surgery for degenerative cervical myelopathy (DCM). Outcome studies for DCM seldom account for the effect of post-surgical rehabilitation. The aim of this study was to quantify the impact of post-surgical rehabilitation on outcomes after surgery for DCM.

Methods: This study is a retrospective analysis of prospectively collected demographic, imaging and outcome data from a single center. Additional chart review was performed to document the timing, type, duration, and outcomes of post-surgical rehabilitation therapy. Outcomes were collected prospectively for the modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and Short Form 36- Physical Component Summary score (SF-36 PCS) at 3, 6 and 12 months after surgery. Linear regression models were created to determine the independent effect of type and timing of post-surgical occupational (OT) and physical therapy (PT) on outcomes.

Results: A total of 66 patients were included in the analysis. Forty-seven patients (71.2%) received either post-surgical outpatient OT or PT. Multivariate regression analysis showed that post-surgical OT was associated with significantly greater improvement in 12-month SF-36 PCS scores (p=0.009) and mJOA scores (p=0.019). Delayed post-surgical therapy (>42 days after surgery) compared to early therapy ( < 42 days after surgery) was associated with smaller improvement in SF-36 PCS scores (p=0.03) at 12 months post-op. Therapy that focused on cervical range of motion/stabilization was associated with greater improvements in SF-36 PCS (p=0.04).

Conclusion : Post-surgical outpatient therapy is independently associated with improved post-surgical outcomes within the first year after surgery for DCM and initiating therapy within 6 weeks after surgery is associated with superior outcomes. This study supports the need for prospective comparative studies for post-surgical rehabilitation using standardized therapy regimens in DCM.