Randomized controlled trial of overall functional exercise process in perioperative of percutaneous transforaminal endoscopic discectomy

Abstract

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has become the standard surgery for the patients of lumbar disc herniation with the advantages of less trauma and rapid recovery. But still some patients have poor prognosis after PTED. A major risk factor associated with the poor prognosis may be the unfit function exercise. Objective: To discuss the effect of overall functional exercise process for PTED. Methods: In January 2019 to June 2020, a single center randomized controlled trial was proceeded. The patients scheduled for PTED were randomly divided into the experimental group, which received overall functional exercise and the control group, which received routine process. The overall process included advance, whole-course exercise and integrating of traditional Chinese medical methods. The general information, visual analog scale (VAS) score and Oswestry Dysfunction Index (ODI) score at each follow-up point perioperative period were compared between the 2 groups. Results: There were no significant differences in the general information, the preoperative VAS and ODI. On the 3rd day after operation, the VAS of low back pain and leg pain in the experimental group were lower than the control group. One month after operation, the VAS of low back pain in the experimental group was lower than that in the control group. One to 3 months after operation, the ODI scores of the experimental group were better than that of the control group. There was no significant difference in modified MacNab index between the experimental group and the control group. Conclusion: Function exercise is important for the prognosis of minimally invasive lumbar surgery. The overall function exercise process perioperative is helpful to relieve the short-term pain of the patients and significantly improve the prognosis.

Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis

“…Only 8 included studies had low risk of bias [ 19 , 20 , 22 , 23 , 25 , 34 , 35 , 37 , 43 ], whereas 14 studies had moderate risk of bias [ 14 , 18 , 28 , 31 , 33 , 38 , 39 , 41 , 47 , 53 – 55 , 58 , 59 ], and 21 studies had high risk of bias [ 15 , 16 , 24 , 26 , 27 , 29 , 30 , 32 , 36 , 40 , 42 , 44 – 46 , 48 – 52 , 56 , 57 ] (see Table 2 ).…”

“…We found a relevant heterogeneity in terms of type, duration, frequency, and intensity of rehabilitation interventions. However, it was noted that in 28 studies [ 14 , 22 – 26 , 28 , 32 – 39 , 42 – 44 , 46 , 48 , 49 , 51 – 55 , 57 , 59 ], rehabilitation started within four weeks after surgery, while in 12 studies [ 15 , 16 , 22 , 26 , 29 , 31 , 41 , 45 , 47 , 50 , 56 , 58 ], physiotherapy began after the fourth postoperative week. Only one study [ 39 ] considered a treatment starting one year after surgery.…”

“…Regarding the type of intervention, most of the supervised exercises were described, although the programs were very heterogeneous. It should be noted that in some studies [ 14 , 16 , 22 – 24 , 26 – 29 , 31 , 32 , 34 – 39 , 42 , 44 , 46 , 51 , 55 , 57 – 59 ] the authors described the details and dosage of each exercise, while others did not reported them [ 15 , 21 , 22 , 25 , 31 , 40 , 41 , 43 , 45 , 47 – 49 , 52 – 54 ]. Extracting and categorizing treatments for both intervention and control groups was very difficult because of the reporting of the articles and the high heterogeneity of interventions’ types and definitions (e.g.…”

Development and Validation of a Nomogram Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Activity Factors

“…They suggest considering delaying the first ambulation. Additionally, Wang et al’s 10 study indicates that engaging in functional exercises one month postoperatively contributes to improving patient prognosis. Controversy persists regarding the relationship between postoperative activity level, time to first ambulation, and the occurrence of PRLDH.…”