Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Hébert, Jeffrey J.; Marcus, Robin L.; Koppenhaver, Shane; Fritz, Julie M.

doi:10.2519/jospt.2010.3332

Cited by 16 publications

(11 citation statements)

References 111 publications

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“…These findings were similar to those found in a study conducted by Hebert et al (2010), who reported that patient experienced clinical improvements in both pain and disability post-application of a rehabilitation program after lumbar discectomy. [21] In our study, better baseline ODI scores predicted better ODI scores (pain improvement) at six months postoperatively. Significant improvements were observed in some dimensions such as: walking, sitting, standing, sleeping, travelling, and sexual and social life.…”

Section: Discussionsupporting

confidence: 90%

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

Abdelmowla

Gamal

Aziz

et al. 2020

JNEP

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Background and aims: Low back pain is mostly due to disc herniation and has a burden upon economy and social aspects of life. Failure to improve after open lumbar discectomy is frustrating. Therefore, identifying predictors of improvement is of great clinical benefit. Aims: This research was conducted to evaluate whether an early exercises rehabilitation program using educational booklet would provide benefit to patients following open lumbar discectomy and determine potential factors of improvement.Patients and methods: Design: Single blind randomized controlled trial. Eighty-eight patients scheduled for open lumbar discectomy from January 2017 to January 2019 at Assiut and Ain Shams Universities hospitals in Egypt were randomly assigned to two groups. Control group (n = 44) received routine postoperative instructions while intervention group (n = 44) received routine instructions in addition to early exercises rehabilitation program and were also provided with a specifically designed educational booklet. Patients were followed up after six months using Oswestry disability index.Results: There was significant improvement among intervention group as compared to control group in several domains of Oswestry disability index (walking, sitting, standing, sleeping, travelling and sexual and social life). Better pre-operative Oswestry disability index score and early application of exercises rehabilitation program using an educational booklet predicted better postoperative Oswestry disability index score after six months.Conclusion: Application of an early exercise rehabilitation program and providing patients with a specifically designed educational booklet would be helpful for patients following open lumbar discectomy. Clinical Relevance: Early exercises rehabilitation program can be used by nursing staff as a reference in management of patients following open lumbar discectomy.

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Section: Discussionsupporting

confidence: 90%

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

Abdelmowla

Gamal

Aziz

et al. 2020

JNEP

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“…Understanding muscle loss in the presence of lumbar spine pathology requires an understanding of how muscle loss occurs with aging. If pathology yields unique rates of muscle loss, new strategies for resolving muscle loss should be a clinical goal for functional improvement, since standard exercise strategies do not appear to reverse these changes in this population (9) (10-12). …”

Section: Introductionmentioning

confidence: 99%

Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration

Shahidi¹,

Parra²,

Berry³

et al. 2017

Spine

128

107

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Study Design Retrospective chart analysis of 199 individuals aged 18-80 years scheduled for lumbar spine surgery. Objective The purpose of this study was to quantify changes in muscle cross sectional area (CSA) and fat signal fraction (FSF) with age in men and women with lumbar spine pathology and compare them to published normative data. Summary of Background Data Pathological changes in lumbar paraspinal muscle are often confounded by age-related decline in muscle size (CSA) and quality (fatty infiltration). Individuals with pathology have been shown to have decreased CSA and fatty infiltration of both the multifidus and erector spinae muscles, but the magnitude of these changes in the context of normal aging is unknown. Methods Individuals aged 18-80 years who were scheduled for lumbar surgery for diagnoses associated with lumbar spine pain or pathology were included. Muscle CSA and FSF of the multifidus and erector spinae were measured from preoperative T2-weighted magnetic resonance images at the L4 level. Univariate and multiple linear regression analyses were performed for each outcome using age and gender as predictor variables. Statistical comparisons of univariate regression parameters (slope and intercept) to published normative data were also performed. Results There was no change in CSA with age in either gender (p>0.05), but women had lower CSA's than men in both muscles (p<0.0001). There was an increase in FSF with age in erector spinae and multifidus muscles in both genders (p<0.0001). Multifidus FSF values were higher in women with lumbar spine pathology than published values for healthy controls (p=0.03), and slopes tended to be steeper with pathology for both muscles in women (p<0.08) but not in men (p>0.31). Conclusions Lumbar muscle fat content, but not CSA changes with age in individuals with pathology. In women, this increase is more profound than age-related increases in healthy individuals.

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“…The improved proprioceptive use after physiotherapy might be caused by a more optimal activation of the multifidus muscles. Hebert et al (2010) observed already decreased intramuscular fat in the multifidus after 8 weeks of physiotherapy following lumbar microdiscectomy. Several studies demonstrated that motor control exercises improve multifidus muscles function and postural control, both by changes on a peripheral (Hides et al, 1996;Tsao and Hodges, 2008) and central level (Tsao et al, 2010).…”

Section: Discussionmentioning

confidence: 76%

“…However, no studies exist on the effect of rehabilitation on postural control after lumbar microdiscectomy. Active over passive treatment after lumbar surgery (Carragee et al, 1999), and an early start of physiotherapy is suggested (Hebert et al, 2010;Millisdotter and Strömqvist, 2007). However, utilization of these parameters appears to be low (Williamson et al, 2007), and significant variability in routine treatment and advice in outpatient care after surgery is observed (Karikari and Isaacs, 2010;Williamson et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

Janssens

Brumagne

Claeys

et al. 2016

Clinical Biomechanics

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Background: Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. Methods: Patients were randomly assigned into transmuscular (n = 12) or paramedian lumbar surgery (n = 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n = 12) or usual care (n = 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. Findings: Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P b 0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P b 0.005), although not seen in the paramedian group and usual care group (P N 0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P b 0.05). Interpretation: Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. Clinical Trial Number: NCT01505595

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Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Cited by 16 publications

References 111 publications

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

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