Rehabilitation following surgery for lumbar spinal stenosis

McGregor, Alison H.; Probyn, Katrin; Doré, Caroline J; Burton, Kim; Cro, Suzie; Crispin, Alexander; Balagué, Federico; Morris, Stephen; Pincus, Tamar; Fairbank, Jeremy

doi:10.1002/14651858.cd009644

Cited by 9 publications

(8 citation statements)

References 35 publications

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“…Lower back pain can recollapse more often in case of weakened paraspinal muscles resulting in instability; the latter can be improved by rehabilitation exercise programs [24, 25]. For disc-herniated patients, microdiscectomy results in minimal atrophy and fatty infiltration to the multifidus muscle [26–29].…”

Section: Discussionmentioning

confidence: 99%

Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation

Sun

Liu

Cheng

et al. 2017

BMC Musculoskelet Disord

126

103

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BackgroundTo assess the correlation between lumbar disc degeneration (LDD), multifidus muscle atrophy (LMA), and facet joints degeneration in patients with L4-L5 lumbar disc herniation (LDH).MethodsSixty patients with L4-L5 LDH diagnosed by a 1.5 T MRI scanner were enrolled in the study group and another 60 patients with non-specific back pain were enrolled in the control group. LDD, LMA, and facet joints degeneration were examined and analyzed independently by two independent orthopedic surgeons using T2-weighted images. Wilcoxon test was used for analyzing the difference of LDD and facet joints degeneration between L3-L4 and L5-S1 and difference of LMA between the herniated and control groups. Correlation analysis of the three degeneration grades at the same level was determined by Spearman rank correlation test.ResultsIn the herniated group, most LMA at L3-L4 level was grade 1 (42, 70.0%); grade 2 (33, 55.0%) at L4-L5 level; and grade 3 (27, 45.0%) at L5-S1 level. LMA and LDD grading were significantly different between L3-L4 and L5-S1 levels (P < 0.05). In the herniation group, the Spearman value for LDD and LMA grading were 0.352 (P < 0.01) at L3-L4 and 0.036 (P > 0.05) at the L5-S1 level. The differences in LMA between the herniated and control groups at the three levels were significant (P < 0.05).ConclusionsDisc degeneration and multifidus muscles atrophy were positively correlated at the L3-L4 disc level. A lumbar extension muscle strengthening program could be helpful in preventing muscle atrophy and lumbar spinal degeneration.

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Section: Discussionmentioning

confidence: 99%

Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation

Sun

Liu

Cheng

et al. 2017

BMC Musculoskelet Disord

126

103

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“…Similar findings were noted for secondary outcomes, including short term improvement in low back pain and long term improvement in both low back pain and leg pain. 131 Role of fusion One of the major controversies about surgery for spinal stenosis is the role of spinal fusion. Spinal arthrodesis with the goal of achieving spinal fusion has generally been recommended for spinal stenosis associated with degenerative spondylolisthesis, recurrent stenosis after previous decompression, instability, or scoliosis.…”

Section: Role Of Postoperative Rehabilitationmentioning

confidence: 99%

Management of lumbar spinal stenosis

Lurie¹,

Tomkins-Lane

2016

BMJ

388

310

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Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

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“…Sinikallio et al, 2007;McKillop et al, 2014;Pakarinen et al, 2014). Although some studies have yielded variable results (Aalto et al, 2011;Abbott et al, 2010;Mannion et al, 2007) for different postsurgical rehabilitation methods (mainly focusing on physiotherapy), postoperative rehabilitation in LSS has proven effective according to a recent meta-analysis (McGregor et al, 2013). Nevertheless, taking psychosocial aspects in consideration in postoperative rehabilitation might improve the outcomes (Abbott et al, 2010;Christensen et al, 2003).…”

mentioning

confidence: 99%

Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis – surgical outcome: A 5-year follow-up study

et al. 2016

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This study investigated the association between the 3-month postoperative sense of coherence and the 5-year postoperative outcome of decompressive surgery for lumbar spinal stenosis. The participants with a lower sense of coherence at the 3-month follow-up had a poorer functional ability and lower satisfaction with surgery, higher pain ratings, lower life satisfaction and more depressive symptoms 5 years postoperatively. A low 3-month sense of coherence associated with greater pain and a poorer functional ability 5 years postoperatively. Evaluating sense of coherence and depressive symptoms in patients who have had lumbar spinal stenosis surgery may help in identifying those in need of enhanced support for postoperative recovery.

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Rehabilitation following surgery for lumbar spinal stenosis

Cited by 9 publications

References 35 publications

Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation

Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation

Management of lumbar spinal stenosis

Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis – surgical outcome: A 5-year follow-up study

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