Effectiveness of physiotherapy interventions after cervical neurosurgery: systematic review and meta-analysis

Abstract

Background There are no clear and standardized recommendations for physiotherapy interventions after cervical neurosurgery. Aim The aim of the present systematic review and meta-analysis was to summarize the latest evidence on postoperative physiotherapy after cervical neurosurgery. Methods A literature search was conducted in electronic databases “ScienceDirect, PubMed, and Web of Science (WoS).” A total of 40,208 studies were accessed via the identified keywords. According to the inclusion and exclusion criteria, a total of 22 articles were included. The “PEDro scale” was used to assess the methodological quality of the included studies. The study protocol has been registered in PROSPERO (Registration number: CRD42024579660). Results Twenty-two studies were included in the systematic review. The included studies were of “good” quality based on the mean PEDro score. Pain and disability were among the most assessed physical outcomes. Physiotherapy interventions have low evidence on the Visual Analog Scale (VAS) in the short term (ES: 0.37) but high evidence on the Neck Disability Index (NDI) in the long term (ES:−0.81; 95% CI:−10.79, 9.16). Conclusions Physiotherapy interventions in addition to surgery may improve recovery. Physiotherapy needs to include structured neck-specific interventions combined with psychosocial approaches. Early home exercises are acceptable and effective. Electrophysiologic agents and manual techniques can be added to treatment in the presence of an appropriate patient population and surgical method. While the level of evidence for physiotherapy interventions is high for disability in the long term, the level of evidence for pain is notable in the short term.