A systematic review and meta-analysis with radiological correlation on the efficacy of spine stabilizing exercises in chronic low backache

Abstract

The objective of this prospective study and systemic review is to analyze the efficacy of stabilizing exercises in the management of spondylolisthesis. Nonspecific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long-term sickness amongst the workforce and is associated with high levels of fear avoidance. Stabilizing (or core stability) exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment there is a lack of positive evidence to support its treatment of NSLBP, and compare any effectiveness to other forms of exercise. Aim: The primary aim of this analysis is to systematically review the most current up to date literature to determine whether stabilization (or core stability) exercises are an effective therapeutic treatment compared to an alternative treatment for the people with Spondylolisthesis. The secondary aim is to determine if stabilization exercises are as effective as other forms of exercise, and to evaluate findings by meta-analysis if appropriate. Methods: A total of 50 non-surgically managed patients with degenerative spondylolisthesis were examined daily for a minimum of 10 days follow-up evaluation. Further follow-up was done evaluation for 1 month, 3 months, and 6 months period. Radiological changes, changes in clinical symptoms, and functional prognosis were surveyed. A comparison of pre-exercises, post exercises and a period of 6 months follow-up for Health-Related Quality of Life using Short-Form 36 Questionnaire was also done. Clinical implications: This article addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self-management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of function and mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Result: A total of 10(20%) of 50 patients who had no neurological deficits at initial examination remained without neurological deficits after 6 months of follow-up. 40(80%) of the 50 patients who had neurological symptoms, such as intermittent claudication, radiating pain at initial examination experienced symptomatic relief. Conclusion:Stabilizing exercises are effective in the management of spondylolisthesis. Physiological and biomechanical factors such as correction of the displaced disc, opening of the foramina increase in intervertebral spaces and reduction in herniation size with negative intradiscal pressure may be possible mechanisms.