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European Spine Journal

, Volume 16, Issue 8, pp 1101–1117 | Cite as

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

  • Anne F. Mannion
  • Raymond Denzler
  • Jiri Dvorak
  • Markus Müntener
  • Dieter Grob
SSE Clinical Science Award 2007

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.

Keywords

Lumbar degenerative disease Decompression surgery Rehabilitation Physiotherapy Self-management 

Notes

Acknowledgments

This study was supported by the Swiss National Science Foundation (Grant no. 32–57123.99) and the Schulthess Klinik Research Funds. We are especially grateful to Renata Heusser, Gordana Balaban and Katrin Knecht for their valuable assistance in managing the study and collecting the data. We also thank Astrid Junge for her help in planning the questionnaires, Maja Husistein and her team for doing the randomisation, Friedrich Bremerich for his medical advice and assistance, Sonja Keller for her help at the start of the study, Arnaldo Benini, Thomas Egloff and Jileli Rhiati for encouraging their patients to participate, and all the physiotherapists who treated the patients and carefully documented their work. We thank Gordon Adam for his assistance in preparing the figures for the manuscript.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Anne F. Mannion
    • 1
  • Raymond Denzler
    • 1
  • Jiri Dvorak
    • 1
  • Markus Müntener
    • 2
  • Dieter Grob
    • 1
  1. 1.Schulthess KlinikZürichSwitzerland
  2. 2.Department of AnatomyUniversity of ZürichZürichSwitzerland

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