The effectiveness of physiotherapy and rehabilitation after cervical spinal surgery: a systematic review

To identify and characterize randomized controlled trials investigating the effectiveness of physiotherapy (PT) after cervical spine surgery in patients with degenerative spinal disease in terms of the effect of PT, and to define the treatment parameters included in the PT program and the initial period, duration, and frequency of these parameters.

PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science were searched up to January 2024. All peer-reviewed articles, including groups of patients who received PT in the postoperative period and those who did not receive PT in this period, were reviewed for inclusion. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials.

A total of 1847 studies were screened, of which 10 randomized controlled trials met the inclusion criteria. All were studies comparing PT + surgery and surgery alone with either standard post-operative care or surgery alone. The PT programs included exercise therapy, cognitive behavioural therapy and optional vestibular rehabilitation. The results in the studies examined showed improvements for patients in all groups in general, and in some parameters, there was a difference in favour of the groups receiving physiotherapy. There was a high risk of bias in all 10 studies.

In all the studies, there were drawbacks such as uncertainty of compliance with the physiotherapy (PT) program and controversial appropriateness. As these studies had a high risk of bias, it cannot be said from this literature whether physiotherapy and rehabilitation after cervical spine surgery is effective. Moreover, factors such as the type and level of surgery and pathologies varied widely in the studies included in this review. A definitive conclusion on the efficacy of PT after cervical spine surgery will be possible with more homogeneous literature and studies with a low risk of bias.