A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine

Abstract

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.

Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

“…Thus, the stability of lumbopelvic and abdominal muscles, as well as the flexibility of hip flexors, hamstrings and lumbar paraspinals was regarded as an important issue in the exercises, which were provided here in the postoperative setting. Our results are in line with the randomized controlled trial by Mannion et al [24] where a 12 week physiotherapeutic intervention (2 9 30 min/week with home exercises) did not lead to any differences between three groups (1. Controls, 2. stabilization exercises and 3. mixed techniques).…”

“…It should be noted that this study could not determine whether our study intervention was better than ''no exercises'' or ''no physiotherapy or guided gym'' because of substantial activity in the B-group. The effect of the patients' own activity on outcome in control group, or the natural postoperative course of the disease was also highlighted in the study of Mannion et al [24].…”

“…At all other follow-ups, the last value was carried forward [19,24]. Missing data about satisfaction at 3-month postoperatively were imputed using the 6-month value.…”

“…This kind of quality of physiotherapy and amount of training would be anticipated to improve the outcome, if the intervention were to have had any effect. The outcome measures were relevant, and have been used in surgical studies of LSS [1,23,24,42]. By used covariates, the effect of initial pain, disability and accumulation of fulfilment of self-acting exercises on outcome could be controlled.…”

“…Postoperative rehabilitation (PR) has been reported to improve outcome after disc surgery [26]. According to Mannion et al [24], supervised rehabilitation had no significant influence in pain and selfrated disability as compared to no treatment/self-management after decompressive lumbar surgery including disc herniation and LSS patients. However, there are no earlier studies of PR examining exclusively LSS patients.…”