Author Names
Gliedt, J., Dawson, A., Daniels, C., Spector A., Cupler, Z., King, J., Egede, L.
Reviewer Name
Anastasia Engelsman
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
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.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Cannot Determine, Not Reported, Not Applicable
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
There is very limited research available regarding the use of manual therapy following spine surgery for degenerative conditions. Only 2 RCT’s have been published on the matter with the remaining research limited to case studies.
Key Finding #2
Manual therapy following cervical spinal surgery for degenerative conditions may result in advantageous clinical outcomes. Positive results were found in 10 out of the 12 articles reviewed in this study. These include: return to work, pain reduction, increased cervical ranges of motion, decreased disability index, increased sensation, increased grip strength, improvement in fear reduction, and reduction of opioid therapy.
Please provide your summary of the paper
The use of surgery for cervical spine degenerative conditions has been increasing, however, there is very little clinical guidance regarding manual therapy in this population. This paper performed a systematic review of all studies analyzing the effects of manual therapy intervention on adults with prior cervical spine surgery due to degenerative conditions. Following systematic review, only 12 articles were identified, consisting of 10 case reports and 2 RTC’s. All studies included the usage of manual joint mobilization and/or table/instrument assisted manipulation. Out of the 12 studies, 10 reported improved clinical outcomes as a result of manual therapy. 2 studies reported serious adverse events. Given that manual therapy is being practiced on individuals following spinal surgery, further research is imperative to examine the safety of this modality on this population.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study demonstrated that manual therapy may elicit positive outcomes for patients who received cervical spinal surgery for degenerative diseases. These positive outcomes may include return to work, pain reduction, increased cervical ranges of motion, decreased disability index, increased sensation, increased grip strength, improvement in fear reduction, and reduction of opioid therapy. This study also found a very high proportion of adverse events when compared to the original sample of the review. It was noted that this may be due to a higher likelihood of
