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Objective <p>Posterior decompression for cervical spondylotic myelopathy (CSM) halts neurological decline, but postoperative rehabilitation remains poorly standardized. Existing literature focuses on isolated modalities rather than an integrated, time-based strategy. We performed a narrative evidence synthesis, rather than a formal systematic review or meta-analysis, to identify optimal rehabilitation timing, progression, and adjunctive modalities after posterior cervical surgery and to propose a structured clinical pathway intended to guide, rather than replace, clinical decision-making.</p> Methods <p>Four databases were searched (PubMed, Embase and MEDLINE [via Ovid], Web of Science; 1990–2025). Studies on postoperative rehabilitation following posterior cervical decompression (laminoplasty or laminectomy ± fusion) were included if they reported pain, function, neurologic recovery, quality of life, or performance outcomes in ≥ 10 patients. Data extraction included intervention type, timing, outcome measures, and functional gains. Narrative synthesis compared early (≤ 4 weeks) vs delayed (&gt; 4 weeks) rehab initiation.</p> Results <p>Twenty-nine studies met criteria. Consistent and early rehabilitation was generally associated with superior outcomes across heterogeneous studies. Among timing-specific studies, 10/13 (77%) demonstrated directionally greater functional gains with earlier rehabilitation initiation; these proportions are descriptive and intended to reflect convergent trends rather than pooled effect sizes. Improvements were seen in JOA, NDI/SF-36 PCS, hand dexterity, and balance. Collar use &gt; 2 weeks did not improve pain or ROM and increased cervical extensor atrophy after non-instrumented posterior decompression, while longer immobilization may be appropriate following multilevel fusion. Adjuncts such as functional electrical stimulation and SEM robotic gloves improved dexterity and endurance in select cases. We propose a four-stage rehabilitation pathway and a conceptual CSM-Rehab Staging Index (CRSI) defining measurable criteria.</p> Conclusion <p>Narrative evidence supports early, phase-based, measurable, and multidisciplinary rehabilitation after posterior cervical surgery. This framework and CRSI are proposed as hypothesis-generating tools requiring prospective validation before routine clinical standardization.</p> Level of evidence <p>IV.</p>

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Rehabilitation strategies following posterior cervical decompression for cervical spondylotic myelopathy: a narrative review and framework for clinical practice

  • 期刊论文

  • 发表日期：

    2026年4月2日

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  • Kartik Akkhial,
  • Aiyana Adams,
  • Devender Singh,
  • Matthew Geck,
  • John Stokes,
  • Eeric Truumees

摘要

Objective

Posterior decompression for cervical spondylotic myelopathy (CSM) halts neurological decline, but postoperative rehabilitation remains poorly standardized. Existing literature focuses on isolated modalities rather than an integrated, time-based strategy. We performed a narrative evidence synthesis, rather than a formal systematic review or meta-analysis, to identify optimal rehabilitation timing, progression, and adjunctive modalities after posterior cervical surgery and to propose a structured clinical pathway intended to guide, rather than replace, clinical decision-making.

Methods

Four databases were searched (PubMed, Embase and MEDLINE [via Ovid], Web of Science; 1990–2025). Studies on postoperative rehabilitation following posterior cervical decompression (laminoplasty or laminectomy ± fusion) were included if they reported pain, function, neurologic recovery, quality of life, or performance outcomes in ≥ 10 patients. Data extraction included intervention type, timing, outcome measures, and functional gains. Narrative synthesis compared early (≤ 4 weeks) vs delayed (> 4 weeks) rehab initiation.

Results

Twenty-nine studies met criteria. Consistent and early rehabilitation was generally associated with superior outcomes across heterogeneous studies. Among timing-specific studies, 10/13 (77%) demonstrated directionally greater functional gains with earlier rehabilitation initiation; these proportions are descriptive and intended to reflect convergent trends rather than pooled effect sizes. Improvements were seen in JOA, NDI/SF-36 PCS, hand dexterity, and balance. Collar use > 2 weeks did not improve pain or ROM and increased cervical extensor atrophy after non-instrumented posterior decompression, while longer immobilization may be appropriate following multilevel fusion. Adjuncts such as functional electrical stimulation and SEM robotic gloves improved dexterity and endurance in select cases. We propose a four-stage rehabilitation pathway and a conceptual CSM-Rehab Staging Index (CRSI) defining measurable criteria.

Conclusion

Narrative evidence supports early, phase-based, measurable, and multidisciplinary rehabilitation after posterior cervical surgery. This framework and CRSI are proposed as hypothesis-generating tools requiring prospective validation before routine clinical standardization.

Level of evidence

IV.