Case Study: Post-Surgical Rehabilitation of Anterior Cervical Discectomy and Fusion (ACDF)

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A 43-Year-Old Male- Managed in Clinical Setting (2010–2012)

During my early years of practice, I treated a 43-year-old male who had undergone Anterior Cervical Discectomy and Fusion (ACDF) due to cervical disc pathology. The patient was referred for post-surgical rehabilitation to improve neck mobility, relieve residual discomfort, and restore functional activity. Unfortunately, I do not recall all the details due to the time that has passed, but I distinctly remember managing the case with a focus on neck exercises and gradual recovery of function.

Presentation:

The patient presented in the post-operative phase with common post-ACDF complaints, including:

• Neck stiffness and reduced mobility

• Mild residual pain on movement

• Apprehension with neck motion, especially with rotation and extension

• Mild postural imbalance and difficulty in prolonged sitting or desk work

Assessment:

Although a detailed assessment record is not available, based on standard practice at that time, I had assessed:

• Cervical range of motion (ROM)

• Pain intensity (likely using a verbal rating scale)

• Posture and scapular alignment

• Functional activities involving head and neck movement

• Any signs of neural tension or upper limb discomfort (radicular symptoms, if any)

Physiotherapy Management:

The rehabilitation protocol was carefully designed to avoid strain on the surgical site, while still promoting gradual recovery. The focus was on improving mobility, strength, posture, and confidence in movement. Here are the key interventions I used:

1. Neck Mobility Exercises (Initially Gentle):

  • Active assisted cervical movements in pain-free range (flexion, extension, side bending, and rotation)
  • Emphasis on slow, controlled motion with proper breathing to reduce muscle guarding

2. Postural Correction and Awareness:

  • Educated the patient on ergonomics and neck-friendly positions during daily tasks
  • Encouraged a neutral spine posture with scapular setting and chin tuck exercises

3. Isometric Neck Strengthening (as tolerated):

  • Once pain levels allowed, I introduced gentle isometric exercises in all directions to rebuild muscle support around the cervical spine

4. Scapular Stabilization and Upper Back Exercises:

  • Strengthening of rhomboids, trapezius, and deep neck flexors to support neck posture
  • Shoulder shrugs, scapular retractions, and upper back stretches were included to reduce compensatory tension

5. Breathing and Relaxation Techniques:

  • To address any residual anxiety or guarding around neck movement, basic breathing and relaxation drills were used, especially during stretching

6. Functional Training and Education:

  • Encouraged the patient to slowly return to daily activities
  • Provided guidance on how to manage neck movements during driving, working, and sleeping

Outcome:

Over a period of several sessions, the patient showed noticeable improvement in neck range of motion and reduction in pain. He reported greater ease in daily activities and increased confidence in neck movement. By the end of the rehab plan, he was able to perform routine activities including desk work, driving, and sleeping without discomfort. The patient expressed satisfaction with the recovery and the structured therapy approach.

This case added to my understanding of post-operative cervical spine care and reinforced the importance of gradual, guided neck rehabilitation following ACDF. It also highlighted the role of patient education, posture correction, and progressive strengthening in achieving long-term functional recovery.


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