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Yu H, Cancelliere C, Mior S, Pereira P, Nordin M, Brunton G, Wong JJ, Shearer HM, Connell G, Ead L, Verville L, Rezai M, Myrtos D, Wang D, Marchand AA, Romanelli A, Germann D, To D, Young JJ, Southerst D, Candelaria H, Hogg-Johnson S, Côté P. Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review. BRAIN & SPINE 2024; 4:102806. [PMID: 38690091 PMCID: PMC11059472 DOI: 10.1016/j.bas.2024.102806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
Introduction The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).
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Affiliation(s)
- Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Undergraduate Education, Canadian Memorial Chiropractic College, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Research and Innovation, Canadian Memorial Chiropractic College, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paulo Pereira
- Faculty of Medicine, University of Porto, Portugal
- Department of Neurosurgery - Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY, USA
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Jessica J. Wong
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Heather M. Shearer
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada
| | - Gaelan Connell
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Lauren Ead
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Verville
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Mana Rezai
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Danny Myrtos
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - Dan Wang
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | | | - Andrew Romanelli
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - Darrin Germann
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - Daphne To
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - James J. Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Danielle Southerst
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Henry Candelaria
- Rapid Access Clinic for Low Back Pain, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Research and Innovation, Canadian Memorial Chiropractic College, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Manni T, Ferri N, Vanti C, Ferrari S, Cuoghi I, Gaeta C, Sgaravatti I, Pillastrini P. Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis. Arch Physiother 2023; 13:21. [PMID: 37845718 PMCID: PMC10578022 DOI: 10.1186/s40945-023-00175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The role of rehabilitation after surgery in patients with low back pain is well recognized. The aim of this systematic review is to summarize and update the existing evidence according to the type of clinical condition and rehabilitation approach. METHODS This systematic review included RCTs on the effectiveness of rehabilitation after surgery for lumbar disc herniation, spinal stenosis, and spondylolisthesis. We searched the literature for randomized controlled trials indexed in MEDLINE, Embase, CINHAL, CENTRAL, Scopus, PEDro, and Web of Science databases, up to April 15, 2023. We used Cochrane Risk of Bias 2.0 tool to assess each study. We conducted a quantitative synthesis when population, intervention, control, and outcome were sufficiently homogeneous; otherwise, we conducted a qualitative analysis. RESULTS Forty-five studies (3.036 subjects) were included and analyzed according to the population considered: lumbar stenosis (1 trial), spondylolisthesis (3 trials), and disc herniation (41 trials). Regarding lumbar stenosis, a supervised active exercise program appears to improve outcomes related to pain, disability, and quality of life both in the short- and mid-term (1 study, n = 60). Concerning spondylolisthesis, kinesiophobia is reduced in the home exercises group compared to usual care, at 3-months follow-up (3 studies, n = 98). For disk herniation, supervised exercises are better than non-supervised exercises to reduce pain (MD -1.14; 95% CIs -1.65, -0.62; 5 trials, n = 250) and disability (SMD -0.70; 95% CIs -1.14, -0.26; 4 trials, n = 175). Supervised exercises are better than advice in reducing pain (SMD -0.91; 95% CIs -1.61, -0.21; 5 trials, n = 341) and disability (SMD -0.80; 95% CIs -1.59, -0.01; 4 trials, n = 261), in the short-term. Supervised exercises are equal to no treatment in reducing pain and disability, at 3 and 6 months after intervention (2 trials, n = 166). These results are supported by a very low to low quality of evidence. CONCLUSIONS Our research suggests that supervised exercise may be effective in improving patient's pain and disability after lumbar surgery, but RCTs regarding lumbar spinal stenosis and lumbar spondylolisthesis are still scarce, with significant heterogeneity of proposed interventions.
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Affiliation(s)
- Tiziana Manni
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy.
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Silvano Ferrari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Ilaria Cuoghi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Claudia Gaeta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Isabella Sgaravatti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
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Rehabilitation to improve outcomes of lumbar fusion surgery: a systematic review with meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1525-1545. [PMID: 35258644 DOI: 10.1007/s00586-022-07158-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of rehabilitation strategies on disability, pain, pain-related fear, and return-to-work in patients undergoing lumbar fusion surgery for degenerative conditions or adult isthmic spondylolisthesis. METHODS Six electronic databases were systematically searched for randomized controlled trials (RCTs) evaluating the effect of rehabilitation (unimodal or multimodal). The estimated effect size was calculated for interventions with homogeneous content using a random-effects model. Certainty of evidence was assessed by GRADE. RESULTS In total, 18 RCTs, including 1402 unique patients, compared specific rehabilitation to other rehabilitation strategies or usual care. Most described indications were degenerative disc disease and spondylolisthesis. All rehabilitation interventions were delivered in the postoperative period, and six of them also included a preoperative component. Intervention dose and intensity varied between studies (ranging from one session to daily sessions for one month). Usual care consisted mostly of information and postoperative mobilization. At short term, low quality of evidence shows that exercise therapy was more effective for reducing disability and pain than usual care (standardized mean difference [95% CI]: -0.41 [-0.71; -0.10] and -0.36 [-0.65; -0.08], four and five studies, respectively). Multimodal rehabilitation consisted mostly of exercise therapy combined with cognitive behavioral training, and was more effective in reducing disability and pain-related fear than exercise therapy alone (-0.31 [-0.49; -0.13] and -0.64 [-1.11; -0.17], six and four studies, respectively). Effects disappeared beyond one year. Rehabilitation showed a positive tendency towards a higher return-to-work rate (pooled relative risk [95% CI]: 1.30 [0.99; 1.69], four studies). CONCLUSION There is low-quality evidence showing that both exercise therapy and multimodal rehabilitation are effective for improving outcomes up to six months after lumbar fusion, with multimodal rehabilitation providing additional benefits over exercise alone in reducing disability and pain-related fear. Additional high-quality studies are needed to demonstrate the effectiveness of rehabilitation strategies in the long term and for work-related outcomes.
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Daniels CJ, Wakefield PJ, Bub GA, Toombs JD. A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice. J Chiropr Med 2016; 15:259-271. [PMID: 27857634 PMCID: PMC5106443 DOI: 10.1016/j.jcm.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 06/23/2016] [Accepted: 08/05/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion. METHODS The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed. RESULTS The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain. CONCLUSIONS This article describes the indications for fusion, common surgical practice, potential complications, and relevant published chiropractic literature. This review includes 10 cases that showed positive benefits from chiropractic manipulation, flexion-distraction, and/or manipulation under anesthesia for postfusion lumbar pain. Chiropractic care may have a role in helping patients in pain who have undergone lumbar fusion surgery.
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Affiliation(s)
- Clinton J. Daniels
- Corresponding author: Clinton J. Daniels, DC, MS, 811 Rowell St, Steilacoom, WA 98388.811 Rowell St., SteilacoomWA98388
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Cho YH, Kim CK, Heo KH, Lee MS, Ha IH, Son DW, Choi BK, Song GS, Shin BC. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract 2014; 15:279-91. [PMID: 24766648 PMCID: PMC4409074 DOI: 10.1111/papr.12208] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 03/01/2014] [Indexed: 12/23/2022]
Abstract
Objectives Acupuncture is commonly used as a complimentary treatment for pain management. However, there has
been no systematic review summarizing the current evidence concerning the effectiveness of
acupuncture for acute postoperative pain after back surgery. This systematic review aimed at
evaluating the effectiveness of acupuncture treatment for acute postoperative pain (≤1 week)
after back surgery. Methods We searched 15 electronic databases without language restrictions. Two reviewers independently
assessed studies for eligibility and extracted data, outcomes, and risk of bias. Random effect
meta-analyses and subgroup analyses were performed. Results Five trials, including 3 of high quality, met our inclusion criteria. The meta-analysis showed
positive results for acupuncture treatment of pain after surgery in terms of the visual analogue
scale (VAS) for pain intensity 24 hours after surgery, when compared to sham acupuncture (standard
mean difference −0.67 (−1.04 to −0.31), P = 0.0003),
whereas the other meta-analysis did not show a positive effect of acupuncture on 24-hour opiate
demands when compared to sham acupuncture (standard mean difference −0.23 (−0.58 to
0.13), P = 0.21). Conclusion Our systematic review finds encouraging but limited evidence for the effectiveness of acupuncture
treatment for acute postoperative pain after back surgery. Further rigorously designed clinical
trials are required.
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Affiliation(s)
- Young-Hun Cho
- School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
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