Short articles by the authors of Cochrane reviews who will describe their research, in their own words.
Rehabilitation following lumbar disc surgery
Version of Record online: 28 MAY 2009
© 2009 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University
Journal of Evidence-Based Medicine
Volume 2, Issue 2, pages 130–131, May 2009
How to Cite
Ostelo, R. (2009), Rehabilitation following lumbar disc surgery. Journal of Evidence-Based Medicine, 2: 130–131. doi: 10.1111/j.1756-5391.2009.01027_3.x
- Issue online: 28 MAY 2009
- Version of Record online: 28 MAY 2009
Sciatica, which is also called lumbosacral radicular syndrome, causes pain that radiates over the buttocks or legs and is combined with phenomena associated with nerve root tension or neurological deficit. The prevailing view is that the condition is most commonly caused by a lumbar disc prolapse, or a ‘slipped’ or ‘herniated’ disc. However, other things may also cause sciatica. Many patients are treated effectively by a combination of non-surgical measures, such as medication or physiotherapy. Patients with persistent symptoms often need to have surgery. About 60% to 90% of patients will improve after this surgery, but some will continue to have symptoms. Perhaps 3% to 12% of patients who have disc surgery will develop another prolapsed disc and most of these patients will have surgery a second time.
After surgery, patients might need rehabilitation and there is a persistent controversy regarding these programs. Many different rehabilitation programs are available and these include things such as stretching, exercise and weight training. But some people have suggested that patients don't need rehabilitation programs at all, after they have been discharged from the hospital. We decided to investigate the evidence, to try to resolve some of the uncertainty around the effectiveness of these treatments by summarising the results for various active treatment programs for patients who had lumbar disc surgery in a Cochrane review.  We focused on patients who had had surgery for the first time. We were interested in finding the effect on pain, global recovery, back pain specific disability and return to work.
We included 14 randomized controlled trials, with approximately 2000 participants, in the review. Most commonly, treatment started four to six weeks after surgery, but in some trials it started in the first two days and in another it lasted for 12 months after the surgery. There was also considerable variation in the content, duration and intensity of the treatments and most of the programs were only assessed in a single trial. Despite these problems, we were still able reach some conclusions.
For programs that started four to six weeks after surgery, we found evidence that patients who took part in exercise programs reported slightly less pain and disability in the short term than those who received no treatment. And, if patients participated in high intensity exercise programs, they reported slightly less pain and disability in the short term than those who had low intensity exercise programs. Finally, patients in trials that compared supervised exercise programs versus exercise programs done at home reported similar pain and disability regardless of which treatment group they were in.
None of the studies in our review reported that active programs increased the chances that a patient would need further surgery, and there was no evidence to suggest that patients should restrict their activities after lumbar disc surgery. However, problems with the methods for half of the trials suggest the results should be read with caution. We still don't know whether all patients should get rehabilitation after surgery or whether it should be kept for just those who still have symptoms four to six weeks after the operation.
So, to sum up, it seems that exercise programs starting 4 to 6 weeks after surgery lead to a quicker relief from pain and disability compared to no treatment. High intensity programs achieve this faster than low intensity programs. For clinical practice, this review shows that it seems to be a good idea to follow an exercise program and return to daily activities as soon as possible after surgery for a prolapsed disk, but the exact timing and content of the rehabilitation program should be discussed with the treating physician.