Cervical ACDF — Anterior Cervical Discectomy and Fusion (ACDF)

Ohio State University Wexner Medical Center · Jordan Hudson DPT, Sean Meers DPT; Reviewed by Andrew Grossbach MD, Jonathan…

Weight-Bearing

Ambulatory; walking program from POD 1 (goal 30 min twice daily); home PT at discharge as needed; OP PT starts at 12 weeks

Key Restrictions

No NSAIDs (timing per surgeon); no tobacco; no driving on narcotics; +/- C-collar per surgeon (osteoporosis, poor bone quality, smoker), may discontinue at 6-12 weeks; lifting, push/pull limit <5-8 lbs until 3 months, then increase 5 lbs every other week; no overhead lifting until 3 months; no end-range cervical stretching; no cervical AROM or prone exercises until 3 months; sitting max 30-45 min; no running, jogging, horseback riding or contact sports until 6 months

Timeline & Phases

Phase 1 (POD 1-12 wks): home walking program, ADL training, posture, sitting <30 min, <5-8 lb limit; Phase 2 (about 12 wks): OP PT 2-3x/wk for 6-8 wks (12-24 visits), NDI at eval, UBE/treadmill/recumbent bike, gentle cervical and scapular retractions, UE conditioning, balance and gait training; Phase 3 (16+ wks): gentle cervical AROM, cervical isometrics in neutral, band/light weight scapular and shoulder strengthening, core and LE strengthening in neutral spine, pec stretching, work simulation, +/- pool; Phase 4 (5-6 months): collar discharged, overhead activity and elliptical begin, cervical/scapular endurance, planks, chops, loaded carries, Pallof press, NDI at discharge; Final phase (6+ months): jogging, running, horseback riding, forward/side planks, deadlifts; Return to work: sedentary/light 6-12 wks, moderate full duty from 16 wks, heavy 12-24 wks after graded restrictions

Notes

Revised April 2022 (created March 2008); replaces OSU's 2021 version, which started OP PT at 4-6 weeks with a 10-20 lb limit; this revision delays OP PT to 12 weeks and lowers the lifting limit to 5-8 lbs for 3 months; NDI outcome measure with MCID goal at discharge; return-to-work table by physical demand level; references include an RCT on collar use after ACDF (Abbott et al 2013)

Surgeon / Author

Jordan Hudson DPT, Sean Meers DPT; Reviewed by Andrew Grossbach MD, Jonathan Karnes MD, Safdar Khan MD, Varun Singh MBBS, Stephanus Viljoen MD, Elizabeth Yu MD, Jennifer Belu APRN-CNP PT, Donald Miller Jr PA-C, Julia Rose EdD PA-C (Ohio State University Wexner Medical Center)

Published

April 2022