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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

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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.

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Acknowledgements

We would like to thank Dr. Graham Gage for his contribution and help in collecting preliminary billing codes as well as Zoë Fresquez for assistance in data extraction.

Funding

No funds, grants, or other support were received.

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Authors and 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

    Justin M. Lantz, Callie Roberts & Lori A. Michener

  2. Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA

    Blake Formanek, Raymond J. Hah, Jeffrey C. Wang & Zorica Buser

  3. USC Spine Physical Therapy Fellowship Program, University of Southern California, Los Angeles, CA, USA

    Justin M. Lantz

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  1. Justin M. Lantz
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Justin Lantz, Zorica Buser, Callie Roberts, and Blake Formanek. The first draft of the manuscript was written by Justin Lantz and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Justin M. Lantz.

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Conflict of interests

Disclosures outside of submitted work: (ZB) Consultancy: Cerapedics (past); Research Support: SeaSpine (past, paid to the institution), Next Science (past, paid directly to institution), Medical Metrics (past, paid directly to institution), NIH SBIR Subaward (past, paid to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Educational Committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee- committee member: Patents (issued): Biomarkers for painful intervertebral discs and methods of use thereof. (JCW): Royalties: SeaSpine, Depuy, Zimmer; Consulting—Precision OS (no money paid); expert testimony; AO Foundation Board (honorarium), National Spine Health Foundation (volunteer); stocks/personal investment: PearlDiver, Bone Biologics, Surgitech; Fellowship Funding (paid to institution): AO Foundation. (RH): Consulting/Royalties: Nuvasive; Research Support (paid to institution): SI-Bone Inc., AETC; Leadership: Editorial Board: Global Spine Journal, Committee: North American Spine Society, Lumbar Spine Research Society. (LM): Leadership: Vice-President-Academy of Orthopedic Physical Therapy (paid), Scientific Advisory Board: PCORI Grant: Operative versus non-operative treatments for atraumatic rotator cuff tears: a multicenter randomized controlled trial; Grants: PAC-12 Student-Athlete Health and Well Being Grant (no number); NIH SBIR Grant; Co-I; 2R44AR074859; The Charles D. and Mary A. Bauer Foundation (no number); Orthopedic Section of the American Physical Therapy Association (no number); Foundation for Physical therapy Research (no number); Triad Labs, New Concord, OH-Contract Virtual Reality; Speaking Honorarium: University of Florida (presentation). (JL): Consulting: SI-Bone Inc; Leadership: Committee member: North American Spine Society, American Academy of Orthopedic Manual Physical Therapists. (CR): No financial or non-financial disclosures to declare. (BF): No financial or non-financial disclosures to declare.

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Lantz, J.M., Roberts, C., Formanek, B. et al. 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 32, 382–388 (2023). https://doi.org/10.1007/s00586-022-07466-7

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