Spinal decompression is the most common type of spinal surgery carried out in the older patient, and is being performed with increasing frequency. Physiotherapy (rehabilitation) is often prescribed after surgery, although its benefits compared with no formal rehabilitation have yet to be demonstrated in randomised control trials. The aim of this randomised controlled trial was to examine the effects on outcome up to 2 years after spinal decompression surgery of two types of postoperative physiotherapy compared with no postoperative therapy (self-management). Hundred and fifty-nine patients (100 men, 59 women; 65 ± 11 years) undergoing decompression surgery for spinal stenosis/herniated disc were randomised to one of the following programmes beginning 2 months post-op: recommended to ''keep active'' (CONTROL; n = 54); physiotherapy, spine stabilisation exercises (PT-StabEx; n = 56); physiotherapy, mixed techniques (PT-Mixed; n = 49). Both PT programmes involved 2 · 30 min sessions/week for up to 12 weeks, with home exercises. Pain intensity (0-10 graphic rating scale, for back and leg pain separately) and self-rated disability (Roland Morris) were assessed before surgery, before and after the rehabilitation phase (approx. 2 and 5 months post-op), and at 12 and 24 months after the operation. 'Intention to treat' analyses were used. At 24 months, 151 patients returned questionnaires (effective return rate, excluding 4 deaths, 97%).Significant reductions in leg and back pain and self-rated disability were recorded after surgery (P < 0.05). Pain showed no further changes in any group up to 24 months later, whereas disability declined further during the ''rehabilitation'' phase (P < 0.05) then stabilised, but with no significant group differences. 12 weeks of post-operative physiotherapy did not influence the course of change in pain or disability up to 24 months after decompression surgery. Advising patients to keep active by carrying out the type of physical activities that they most enjoy appears to be just as good as administering a supervised rehabilitation program, and at no cost to the health-care provider.

As the average life expectancy of the population increases, surgical decompression of the lumbar spine is being performed with increasing frequency. It now constitutes the most common type of lumbar spinal surgery in older patients. The present prospective study examined the 5-year outcome of lumbar decompression surgery without fusion. The group comprised 159 patients undergoing decompression for degenerative spinal disorders who had been participants in a randomised controlled trial of post-operative rehabilitation that had shown no between-group differences at 2 years. Leg pain and back pain intensity (0-10 graphic rating scale), self-rated disability (Roland Morris), global outcome of surgery (5-point Likert scale) and re-operation rates were assessed 5 years post-operatively. Ten patients had died before the 5-year follow-up. Of the remaining 149 patients, 143 returned a 5-year follow-up (FU) questionnaire (effective return rate excluding deaths, 96%). Their mean age was 64 (SD 11) years and 92/143 (64%) were men. In the 5-year follow-up period, 34/143 patients (24%) underwent re-operation (17 further decompressions, 17 fusions and 1 intradural drainage/debridement). In patients who were not re-operated, leg pain decreased significantly (p < 0.05) from before surgery to 2 months FU, after which there was no significant change up to 5 years. Low back pain also decreased significantly by 2 months FU, but then showed a slight, but significant (p < 0.05), gradual increase of <1 point by 5-year FU. Disability decreased significantly from pre-operative to 2 months FU and showed a further significant decrease at 5 months FU. Thereafter, it remained stable up to the 5-year FU. Pain and disability scores recorded after 5 years showed a significant correlation with those at earlier follow-ups (r = 0.53-0.82; p < 0.05). Patients who were re-operated at some stage over the 5-year period showed significantly worse final outcomes for leg pain and disability (p < 0.05). In conclusion, pain and disability showed minimal change in the 5-year period after surgery, but the re-operation rate was relatively high. Re-operation resulted in worse final outcomes in terms of leg pain and disability. At the 5-year follow-up, the "average" patient experienced frequent, but relatively low levels of, pain and moderate disability. This knowledge on the long-term outcome should be incorporated into the pre-operative patient information process.

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