Secondary Logo

Institutional members access full text with Ovid®

Guidelines for Rehabilitation and Return to Play After Cervical Surgery in a General Athletic Population

A Delphi Analysis

Robben, Elise, MD*; Kempeneers, Kristof, MD; De Groef, An, PT, PhD*,‡; Depreitere, Bart, MD, PhD§; Peers, Koen, MD, PhD*

doi: 10.1097/JSM.0000000000000729
Original Research: PDF Only

Objective: Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no clear guidelines for this are currently available. The aim of this study was to create tentative guidelines for rehabilitation and RTP after cervical surgery in a general sporting population.

Design: Five-step Delphi analysis.

Settings: Primary, secondary, and tertiary medical practitioners.

Participants: Panel of Belgian neurosurgeons, orthopedic surgeons, physiotherapists, and physical and rehabilitation medicine practitioners.

Assessment: Round 1 (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3), experts ranked these items in a chronological order. Contraindications and criteria to start each rehabilitation step were linked in round 4 (R4). In round 5 (R5), panelists ranked theses about contraindications and criteria on a 5-point Likert scale.

Main Outcome Measures: Theses scoring ≥10% “oppose” or “strongly oppose” were rejected.

Results: The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4, and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed.

Conclusions: This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and RTP after cervical surgery in a general athletic population. Tentative guidelines and timetable are proposed. Key messages from these guidelines are (1) Rehabilitation should start before surgery with education; (2) Rehabilitation should be patient-tailored; and (3) An unstable arthrodesis is an absolute contraindication for RTP.

*Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium;

Department of Physical and Rehabilitation Medicine, Jessa Ziekenhuis, Hasselt, Belgium;

Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium. Dr. De Groef is a post-doctoral research fellow of the FWO-Flanders, Brussels, Belgium; and

§Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.

Corresponding Author: Elise Robben, MD, Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium (

The authors report no conflicts of interest.

Received August 14, 2018

Accepted November 14, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.