Objective To explore the developmental trajectories of postoperative functional exercise adherence in patients with cervical spondylosis and analyze its influencing factors, so as to provide evidence for formulating personalized and multi-level rehabilitation support strategies. Methods A total of 262 patients with cervical spondylosis who underwent anterior cervical discectomy and fusion(ACDF) surgery were enrolled. The Exercise Adherence Rating Scale (ERAS) was adopted to assess their adherence to functional exercise at five follow-up time points:1 week, 1 month, 3 months, 6 months and 12 months after surgery. Mixed latent growth model was used to identify subgroups of developmental trajectories of functional exercise adherence, and relevant influencing factors were further analyzed.Results The postoperative functional exercise adherence trajectories were classified into three distinct patterns: continuously decreasinggroup (62 cases, 23.66%), stablegroup (78 cases, 29.77%), and sharp-drop-slow-rise group(122 cases, 46.57%). Self-control ability, activities of daily living, educational level, monthly per capita household income, pain, kinesiophobia and personality traits were significant influencing factors for the subgroups of functional exercise adherence trajectories (all P<0.05). Conclusion There are distinct differences in the changing trajectories of functional exercise adherence among patients after cervical spondylosis surgery, and such differences are affected by multiple factors. Clinical nurses should implement classified management for patients and match differentiated rehabilitation protocols accordingly to improve their exercise adherence.