Clinical Orthopaedics and Related Research®

, Volume 470, Issue 6, pp 1658–1667

Prolonged Bed Rest as Adjuvant Therapy After Complex Reconstructive Spine Surgery

  • Rex A. W. Marco
  • Ryan M. Stuckey
  • Stephanie P. Holloway
Symposium: Complications of Spine Surgery

Abstract

Background

The benefits of postoperative mobilization include decreased incidence of pulmonary complications, pressure ulcers, and progression of deep vein thrombosis. However, the complexity of certain spinal reconstructions and the patient’s physiologic condition may preclude the possibility of early mobilization. Prolonged bed rest after spine surgery is controversial.

Questions/purposes

We evaluated the efficacy of prolonged bed rest after complex spine surgery to determine (1) patient characteristics that led to prescribing bed rest, (2) clinical and radiographic outcomes, (3) complications, and (4) estimated direct costs.

Methods

We retrospectively reviewed all 11 patients (median age, 50 years) who underwent complex spine surgery followed by prolonged bed rest between 2005 and 2010. All patients were deemed at high risk for developing pseudarthrosis or instrumentation failure without postoperative bed rest. One patient died of complications related to pulmonary tuberculosis at 4 months. The patients averaged 3 months of bed rest. Minimum followup was 24 months (median, 30 months; range, 4–52 months).

Results

All patients had (1) tenuous or limited fixation after correction of severe deformity, (2) previously failed spine reconstruction after early mobilization, or (3) limited treatment options if failure occurred again. No patient experienced pseudarthrosis, failure of instrumentation, thromboembolic disease, pressure ulcers, or pneumonia. One patient had a delayed union and one developed late urosepsis. The median cost of skilled nursing facilities during the period of bed rest was $16,702, while the median cost of home health nursing was $5712.

Conclusions

For patients with contraindications to early postoperative mobilization, prolonged bed rest may be useful to minimize the risk of complications that can occur with mobilization.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

References

  1. 1.
    Allman RM, Goode PS, Patrick MM, Burst N, Bartolucci AA. Pressure ulcer risk factors among hospitalized patients with activity limitation. J Am Med Assoc. 1995;273:865–870.CrossRefGoogle Scholar
  2. 2.
    Arkin AM. Correction of structural changes in scoliosis by corrective plaster jackets and prolonged recumbency. J Bone Joint Surg Am. 1964;46:33–52.PubMedGoogle Scholar
  3. 3.
    Belavý DL, Miokovic T, Armbrecht G, Richardson CA, Rittweger J, Felsenberg D. Differential atrophy of the lower-limb musculature during prolonged bed-rest. Eur J Appl Physiol. 2009;107:489–499.PubMedCrossRefGoogle Scholar
  4. 4.
    Bleeker MW, De Groot PC, Rongen GA, Rittweger J, Felsenberg D, Smits P, Hopman MT. Vascular adaptation to deconditioning and the effect of an exercise countermeasure: results of the Berlin Bed Rest Study. J Appl Physiol. 2005;99:1293–1300.PubMedCrossRefGoogle Scholar
  5. 5.
    Dang Y, Yen D, Hopman W. Postoperative bed rest improves the alignment of thoracolumbar burst fractures treated with the AO spinal fixator. Can J Surg. 2009;52:215–220.PubMedGoogle Scholar
  6. 6.
    Demiot C, Dignat-George F, Fortrat JO, Sabatier F, Gharib C, Larina I, Gauquelin-Koch G, Hughson R, Custaud MA. WISE 2005: chronic bed rest impairs microcirculatory endothelium in women. Am J Physiol Heart Circ Physiol. 2007;293:H3159–H3164.PubMedCrossRefGoogle Scholar
  7. 7.
    Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med. 1986;315:1064–1070.PubMedCrossRefGoogle Scholar
  8. 8.
    Dindo D, Demartines N, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.PubMedCrossRefGoogle Scholar
  9. 9.
    Dittmer DK, Teasell R. Complications of immobilization and bed rest. Part 1. Musculoskeletal and cardiovascular complications. Can Fam Physician. 1993;39:1428–1432.PubMedGoogle Scholar
  10. 10.
    Dorfman TA, Levine BD, Tillery T, Peshock RM, Hastings JL, Schneider SM, Macias BR, Biolo G, Hargens AR. Cardiac atrophy in women following bed rest. J Appl Physiol. 2007;103:8–16.PubMedCrossRefGoogle Scholar
  11. 11.
    Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia, Part I. Paraplegia. 1969;7:179–192.CrossRefGoogle Scholar
  12. 12.
    Hides JA, Belavý DL, Stanton W, Wilson SJ, Rittweger J, Felsenberg D, Richardson CA. MRI assessment of trunk muscles during prolonged bed rest. Spine (Phila Pa 1976). 2007;32:1687–1692.CrossRefGoogle Scholar
  13. 13.
    Jacobs RR, Asher MA, Snider RK. Thoracolumbar spinal injuries: a comparative study of recumbent and operative treatment in 100 patients. Spine (Phila Pa 1976). 1980;5:463–477.CrossRefGoogle Scholar
  14. 14.
    Kinoshita H, Nagata Y, Ueda H, Kishi K. Conservative treatment of burst fractures of the thoracolumbar and lumbar spine. Paraplegia. 1993;31:58–67.PubMedCrossRefGoogle Scholar
  15. 15.
    Lenke LG, Bridwell KH, Bullis D, Betz RR, Baldus C, Schoenecker PL. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord. 1992;5:433–442.PubMedCrossRefGoogle Scholar
  16. 16.
    McEvoy RD, Bradford DS. The management of burst fractures of the thoracic and lumbar spine: experience in 53 patients. Spine (Phila Pa 1976). 1985;10:631–637.CrossRefGoogle Scholar
  17. 17.
    Medical Research Council Working Party on Tuberculosis of the Spine. A controlled trial of anterior spinal fusion and débridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in two centres in South Africa. Seventh Report of the Medical Research Council Working Party on Tuberculosis of the Spine. Tubercle. 1978;59:79–105.CrossRefGoogle Scholar
  18. 18.
    Mumford J, Weinstein JN, Spratt KF, Goel VK. Thoracolumbar burst fractures: the clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976). 1993;18:955–970.CrossRefGoogle Scholar
  19. 19.
    Oner FC, van Gils AP, Faber JA, Dhert WJ, Verbout AJ. Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging: prospective study of 53 patients with 71 fractures. Spine (Phila Pa 1976). 2002;27:629–636.CrossRefGoogle Scholar
  20. 20.
    Pakzad H, Roffey DM, Knight H, Dagenais S, Yelle J, Wai EK. Delay in operative stabilization of spine fractures in multitrauma patients without neurologic injuries: effects on outcomes. Can J Surg. 2011;54:270–276.PubMedCrossRefGoogle Scholar
  21. 21.
    Parker H, Wood P, Main C. The use of pain drawing as a screening measure to predict psychological distress in chronic low back. Spine (Phila Pa 1976). 1995;20:236–243.CrossRefGoogle Scholar
  22. 22.
    Partsch H. Bed rest versus ambulation in the initial treatment of patients with proximal deep vein thrombosis. Curr Opin Pulm Med. 2002;8:389–393.PubMedCrossRefGoogle Scholar
  23. 23.
    Rechtine GR. Nonoperative management and treatment of spinal injuries. Spine (Phila Pa 1976). 2006;31(11 suppl):S22–S27.CrossRefGoogle Scholar
  24. 24.
    Sievanen H. Immobilization and bone structure in humans. Arch Biochem Biophys. 2010;503:146–152.PubMedCrossRefGoogle Scholar
  25. 25.
    Slipman CW, Lipetz JS, Jackson HB, Vresilovic EJ. Deep venous thrombosis and pulmonary embolism as a complication of bed rest for low back pain. Arch Phys Med Rehabil. 2000;81:127–129.PubMedGoogle Scholar
  26. 26.
    Teasell R, Dittmer DK. Complications of immobilization and bed rest. Part 2. Other complications. Can Fam Physician. 1993;39:1440–1446.PubMedGoogle Scholar
  27. 27.
    Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop. 2005;29:78–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Van Duijnhoven NT, Bleeker MW, de Groot PC, Thijssen DH, Felsenberg D, Rittweger J, Hopman MT. The effect of bed rest and an exercise countermeasure on leg venous function. Eur J Appl Physiol. 2008;104:991–998.PubMedCrossRefGoogle Scholar
  29. 29.
    Wang T, Zeng B, Xu J, Chen H, Zhang T. Radiographic evaluation of selective anterior thoracolumbar or lumbar fusion for adolescent idiopathic scoliosis. Eur Spine J. 2008;17:1012–1018.PubMedCrossRefGoogle Scholar
  30. 30.
    Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine (Phila Pa 1976). 1988;13:33–38.CrossRefGoogle Scholar
  31. 31.
    Wiltse LL, Bateman G, Hutchinson RH, Nelson WE. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am. 1968;50:919–926.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Rex A. W. Marco
    • 1
    • 2
  • Ryan M. Stuckey
    • 1
  • Stephanie P. Holloway
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Texas Medical School at HoustonBellaireUSA
  2. 2.Department of Neurosurgery and Spine Surgery and Musculoskeletal OncologyUniversity of Texas Medical School at HoustonHoustonUSA

Personalised recommendations