National audit of post-operative management in spinal surgery

McGregor, Alison H.; Dicken, Ben; Jamrozik, Konrad

doi:10.1186/1471-2474-7-47

Cited by 54 publications

(52 citation statements)

References 24 publications

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“…The answer to this dilemma is beyond the scope of this study and requires further research in the form of randomised controlled studies, ideally with a control population that permits the natural course of the disease to be assessed. Recent reviews of post-operative practice have noted clear inconsistencies within and between surgeons with regard to post-operative management and advice [ [29]]. This can make patients uncertain and reluctant to return to normal activities.…”

Section: Discussionmentioning

confidence: 99%

The outcome of spinal decompression surgery 5 years on

2007

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Decompression surgery is an increasingly common operation for the treatment of lumbar spinal stenosis. Although good relief from leg pain is expected after surgery, long term results of pain relief and function are more uncertain. This study prospectively followed a cohort of patients presenting with the signs and symptoms of spinal stenosis, who underwent decompression surgery to ascertain the long term outcome with respect to pain and function using visual analogue pain scores, the Oswestry Disability Index, and the Short Form 36, a general health questionnaire. From an initial pool of 84 recruited patients, 7 withdrew from surgical intervention; of the remaining 77, 51 (66%) returned for follow up assessments at 5 years. In these responders, a significant improvement was observed in back and leg pain, which was sustained for at least 1 year (P < 0.01). A significant improvement was also seen in physical function (P < 0.05) as assessed by Oswestry and SF-36. Although an initial improvement was noted in social function, this was not observed at 5 years. This study has demonstrated that decompression surgery is successful in relieving symptoms of lumbar spinal stenosis. Physical function, back and leg pain are significantly improved after 5 years but initial significant improvements in social function diminish over time.

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Section: Discussionmentioning

confidence: 99%

The outcome of spinal decompression surgery 5 years on

2007

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“…Moreover, a matched control group without lumbar surgical history would have improved the study design. A prospective study with a large sample size must reveal whether proprioceptive measures can select patients at risk of residual complaints after lumbar surgery (den Boer et al, 2010) and, consequently, improve targeted care for lumbar microdiscectomy patients (Costa et al, 2013;McGregor et al, 2006;van der Windt and Dunn, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…The emphasis on the early and active component of physiotherapy was based on previous evidence (McGregor et al, 2006). Eight to 15 sessions of physiotherapy were administered during a maximum period of 12 weeks.…”

Section: Physiotherapymentioning

confidence: 99%

“…Short term after surgery, lumbar microdiscectomy provides more rapid recovery than non-operative treatment, but no difference in functionality and pain is found in the long run (Jacobs et al, 2011b;Loupasis et al, 1999). The underlying mechanisms of these residual complaints remain largely unknown, although identification of these factors is listed as a high research priority in this research area (Costa et al, 2013;McGregor et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…Optimizing clinical outcomes after lumbar surgery is recognized as a priority for future research (McGregor et al, 2006). Identifying specific and adaptable underlying mechanisms can support the development of tailored interventions (van der Windt and Dunn, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

Janssens

Brumagne

Claeys

et al. 2016

Clinical Biomechanics

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Background: Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. Methods: Patients were randomly assigned into transmuscular (n = 12) or paramedian lumbar surgery (n = 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n = 12) or usual care (n = 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. Findings: Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P b 0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P b 0.005), although not seen in the paramedian group and usual care group (P N 0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P b 0.05). Interpretation: Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. Clinical Trial Number: NCT01505595

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Prehabilitation for Patients Undergoing Orthopedic Surgery

et al. 2023

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ImportancePrehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results.ObjectiveTo evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery.Data SourcesBibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022.Study SelectionRandomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included.Data Extraction and SynthesisTwo independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresPain, function, muscle strength, and health-related quality of life (HRQOL).ResultsForty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], −0.70 [95% CI, −1.08 to −0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, –8.20 [95% CI, −8.85 to −7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, −0.51 [95% CI, −0.85 to −0.17]) and at 6 months in those undergoing lumbar surgery (SMD, −2.35 [95% CI, −3.92 to −0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence.Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.

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National audit of post-operative management in spinal surgery

Abstract: Background: There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial.

Cited by 54 publications

References 24 publications

The outcome of spinal decompression surgery 5 years on

The outcome of spinal decompression surgery 5 years on

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

Prehabilitation for Patients Undergoing Orthopedic Surgery

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