• Gliedt JA
• Dawson AZ
• Daniels CJ
• Spector AL
• Cupler ZA
• King J
• Egede LE

• Affiliation / Butler VA Health Care System
• Affiliation / Medical College of Wisconsin. Center for Advancing Population Science
• Affiliation / Medical College of Wisconsin. Center for Advancing Population Science
• Affiliation / Medical College of Wisconsin. Department of Medicine. Division of General Internal Medicine
• Affiliation / Medical College of Wisconsin. Department of Neurosurgery
• Affiliation / Medical College of Wisconsin. Institute for Health and Equity
• Affiliation / University of Pittsburgh. School of Medicine. Institute for Clinical Research Education
• Affiliation / VA Puget Sound Health Care System
• Affiliation(G) / United States / Pennsylvania / Butler
• Affiliation(G) / United States / Pennsylvania / Pittsburgh
• Affiliation(G) / United States / Washington / Tacoma
• Affiliation(G) / United States / Wisconsin / Milwaukee
• Cervical Vertebrae / surgery
• Manipulation, Spinal
• Musculoskeletal Manipulations
• Open Access Document
• Postoperative Care

Objective: Cervical spine surgeries for degenerative conditions are rapidly increasing. Cervical post-surgery syndrome consisting of chronic pain, adjacent segment disease, recurrent disc herniation, facet joint pain, and/or epidural scarring is common. Repeat surgery is regularly recommended, though patients are often unable to undergo or decline further surgery. Manual therapy is included in clinical practice guidelines for neck pain and related disorders, however clinical guidance for utilization of manual therapy in adults with prior cervical spine surgery is lacking. This study aimed to synthesize available literature and characterize outcomes and adverse events for manual therapy interventions in adults with prior cervical spine surgery due to degenerative conditions.

Methods: Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was followed. PubMed, Cumulative Index of Nursing and Allied Health Literature, physiotherapy evidence database, and Index to Chiropractic Literature were searched from inception through October 2021. English-language literature comprised of randomized clinical trials (RCT), case–control, cohort, and case report designs were included. Adults undergoing manual therapy, with or without combination of other interventions, with prior cervical spine surgery due to degenerative conditions were included.

Results: Twelve articles were identified, including 10 case reports, 1 low-quality RCT, and 1 acceptable-quality RCT. Eight case reports described 9 patients with history of fusion surgery. Two case reports described 2 patients with history of discectomy. One case report described one patient with separate operations of a discectomy at one level and a fusion at another level. One case report described 2 patients with history of cervical disc replacement surgery. The two RCTs included 63 and 86 participants, respectively. Use of manual joint mobilization/manipulation, table/instrument assisted mobilization/manipulation, and multimodal interventions were described in eligible studies. Favorable clinical outcomes were reported in 10 studies. Six case reports/series involving 8 patients described use of unclassified forms of manual therapy. Eight studies described the use of multimodal interventions along with manual therapy. One study described high patient satisfaction. Two studies, accounting for 3 patients, reported serious adverse events.

Conclusions: There is a lack of literature informing evidence related to clinical outcomes, patient satisfaction, and adverse events associated with manual therapy for patients with prior cervical spine surgery due to degenerative conditions. High-quality studies of higher-level hierarchical study design are needed to understand the clinical utility and safety profile of manual therapy for this population.

Author keywords: Postsurgical - Postoperative periods - Cervical post-surgical syndrome - Spinal manipulation - Manual therapy

Author affilations: JAG, AZD, ALS: Center for Advancing Population Science, Medical College of Wisconsin, WI, Milwaukee, USA; JAG, JK: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; AZD, LEE: Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; CJD: VA Puget Sound Health Care System, Tacoma, WA, USA; ALS: Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; ZAC: Butler VA Health Care System, Butler, PA, USA; ZAC: Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; LEE: Center for Advancing Population Science, Medical College of Wisconsin, WI, Milwaukee, USA.

Corresponding author: Leonard E Egede: legede@mcw.edu

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