Authors (including presenting author) :
Ngan YK(1), Lee CH(1), Yung JMW(1) , Lai WC(1), Tsang NC(1), Wan S(1), Kwong S(2), Yeung SF(1), Lui WM(2), Mok WY(3), Yam SK(3)
Affiliation :
(1)Physiotherapy Department, PYNEH, (2)Physiotherapy Department, RTSKH, (3)O&T Department, HKEC
Introduction :
Decompression is a common surgical technique used to treat various cervical spine pathologies. Surgeons would decide different types of decompression surgeries depends on patient’s disease type and spinal stability. Physiotherapists have the role as case manager to provide care throughout the patient journey in Spine Triage Program in HKEC.
Objectives :
1. To triage spinal referrals in spine team, category cases to different pathology groups and provide fast-track service
2. To provide physiotherapy assessment and treatment before and after surgery
3. To evaluate functional outcomes after surgery
Methodology :
From January 2016 to May 2022, 62 patients (mean age 62.7 years, 74.2% male) underwent cervical decompression surgery were assessed preoperatively, 6-month and 2-year postoperatively. Types of decompression surgeries included anterior and posterior spinal fusion, laminectomy, and discectomy. Outcome measures included Flip Coin Test, Handgrip Strength, Timed Up and Go Test (TUGT), 6-Minute Walk Test (6MWT) and Tinetti Test were used to assess changes in hand dexterity, muscle strength, walking performance and balance. Physiotherapy interventions included core strengthening, activity modification, neural mobilization, balance training and fall prevention.
Result & Outcome :
There was statistically significant improvement in 6MWT in 2-year (from 359.6m to 393.6m, p=0.002) and in all flip coin tests in 6-month and 2-year (p< or =0.001). Handgrip strength was significantly improved in 6-month and 2-year (from 45.8kg to 51.6kg, p< 0.001 and to 53.0kg, p< 0.001). There was significant improvement in Tinetti Test in 6-month and 2-year in balance score (from 12.7 to 13.9, p=0.002 and to 14.2, p=0.001) and in gait score (from 9.2 to 10.2, p< 0.001 and to 10.2, p< 0.001). Limited improvement was observed in TUGT (p=0.526).
In subgroup analysis, for age ≥65, handgrip strength improvement was significant in 6-month and 2-year. Tinetti balance score was significantly improved after 2 years, also in gait score in 6-month and 2-year.
Functional outcomes were improved after cervical decompression surgery and was beneficial for patients aged ≥65. It shows that collaboration of physiotherapy and orthopedics in triage spine clinic has significant role in managing patients receiving cervical decompression surgery, and able to improve physical functions, especially in gait and balance domains, possibly reduces fall and mortality.
