Effectiveness of Postsurgical Rehabilitation Following Lumbar Disc Herniation Surgery

Lumbar disc herniation (LDH) with radiculopathy is a common condition we encounter in clinical practice, with an annual prevalence of about 2% in the general population. Normally, the prognosis is good for these patients, but as with most conditions, a small proportion of patients go on to experience more non-responsive, progressive or severe clinical presentations. For lumbar disc herniations, about 10% of patients have symptoms lasting longer than 6 weeks and may eventually consider surgery. Approximately half of all surgeries performed on the lumbar spine are for disc herniation with radiculopathy, making it the most common reason for lumbar surgery in working age adults. 

For those that eventually require surgery, post-operative rehabilitation is recommended to preserve optimal function and promote healing. The World Health Organization defines rehabilitation as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning when interacting with their environments”. In general, rehabilitation can include clinical and community-based interventions.

To date, little is known about the most effective rehabilitation approaches to improve outcomes after LDH surgery. Previous reviews on this topic need to be updated due to outdated literature searches, methodological limitations, inconsistent findings and a lack of inclusion of safety data. 

Therefore, the purpose of this systematic review was to evaluate the effectiveness and safety of post-surgical rehabilitation interventions delivered in any setting to improve pain, function and other health outcomes in adults who have received LDH surgery.

Excerpt from the Review (“Clinical Application & Conclusions”):

More high-quality research is needed in this area, but the authors appropriately underscored the importance of a flexible, patient-centred approach to rehabilitation for these patients. This includes a deep understanding of an individual’s needs, preferences and the specific context of their recovery journey. Specific components of such an approach can include:

1. Tailored rehabilitation approaches – incorporate Pilates (based on these results) or some other form of exercise the patient will commit to and perform safely. 
2. Comprehensive patient assessment – gather information about their rehabilitation planning, current condition, psychological and social status, the nature of their surgery and personal recovery aspirations.
3. Patient centred outcomes – use meaningful outcome measures such as the WHODAS 2.0 and Patent-Specific Functional Scale (PSFS).
4. Dynamic rehabilitation strategy – regularly review the plan and the patient’s progress, incorporating the patient’s feedback and evolving needs.
5. Shared decision-making – collaborate with the patient and select interventions that align with their values, goals and preferences.
6. Interdisciplinary collaboration and continued learning – a team approach can be employed where possible, with various perspectives considered in a comprehensive, holistic rehabilitation plan that keep both clinicians and the patient updated via the latest evidence and innovations.

RESEARCH REVIEW: Effectiveness of Postsurgical Rehabilitation Following Lumbar Disc Herniation Surgery

This paper was published in Brain and Spine (2024)

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