Early Rehabilitation Targeting Cognition, Behavior, and Motor Function After Lumbar Fusion

Abstract

The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

“…Furthermore, strong influences and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion have been shown [1]. In addition to our own observations in a randomised controlled trial [2], a previous study showed the importance of post-operative rehabilitation for the outcome of lumbar fusion [4]. In both trials, biopsychosocially orientated rehabilitation was more effective than exercise therapy in improving functional outcome [2,4].…”

“…In 99 of the patients, decompression was performed by full laminectomy and partial facet joint resection in central spinal stenosis and spondylolisthesis (isthmic and degenerative) or by partial facet joint resection in root canal stenosis. The patients participated in a randomised controlled trial analysing the short-and long-term effectiveness of a psychomotor therapy (N = 53) compared with an exercise therapy (N = 54) applied during the first 3 months after lumbar fusion [2]. Psychomotor therapy combined cognitivebehavioural and motor relearning strategies to modify maladaptive pain cognitions, behaviour and motor control.…”

Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up

“…Thus far, a limited number of randomised controlled trials (RCTs) have been published and the evidence of exercise therapy in restoring the spinal functioning and improving disability or HRQoL after fusion surgery is weak [10][11][12][13][14][15][16]. The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17].…”

“…The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17]. Most trials were implemented close to time of surgery, starting preoperatively [13,14], during hospital stay or soon after discharge [10,12].…”

“…Most trials were implemented close to time of surgery, starting preoperatively [13,14], during hospital stay or soon after discharge [10,12]. The two trials, which have been measuring disability and health related quality of life, indicate that combination of exercises and cognitive-behavioral therapy is more effective than exercises alone, when implemented within first postoperative months [10,12]. Because the existing evidence concerning exercise rehabilitation after LSF is limited and controversial, there is no consensus on the contents of effective rehabilitation program after LSF.…”