The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression

Abstract

Post-operative management after lumbar surgery is inconsistent leading to uncertainty amongst surgeons and patients about post-operative restrictions, reactivation, and return to work. This study aimed to review the evidence on post-operative management, with a view to developing evidence-based messages for a patient booklet on post-operative management after lumbar discectomy or un-instrumented decompression. A systematic literature search produced a best-evidence synthesis of information and advice on post-operative restrictions, activation, rehabilitation, and expectations about outcomes. Evidence statements were extracted and developed into patient-centred messages for an educational booklet. The draft text was evaluated by peer and patient review. The literature review found little evidence for post-operative activity restrictions, and a strong case for an early active approach to postoperative management. The booklet was built around key messages derived from the literature review and aimed to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice on self-management. Feedback from the evaluations were favourable from both review groups, suggesting that this evidence-based approach to management is acceptable and it has clinical potential.

The outcome of spinal decompression surgery 5 years on

“…Combined with the deconditioned state many patients present with [1,16,23,25,33,39] this may explain the low improvements in function observed. This lack of post-operative advice has now been addressed in the form of a patient education booklet [28], the value of which is currently being explored in a randomised controlled study.…”

A survey of the “surgical and research” articles in the European Spine Journal, 2007

“…The paper by McGregor et al [34] conducted a systematic literature search, and reviewed the evidence on post-operative management, and found that there was a little evidence for any post-operative restrictions, and a strong case for an early active approach. This message was extracted and developed into a patient centred message in an educational booklet.…”

The Effect of an Early Lumbar Exercise Program on Trunk Strength and the Oswestry Disability Index after Herniated Nucleus Pulposus Surgery

“…The medication and conservation methods, for example complete bed rest, have generally been used for treatment after herniated nucleus pulposus (HNP) surgery, but the negative effects of these methods have often been reported 1,2) . One possible reason is that so-called deconditioning syndrome increases pain and reduces motor functions after surgery 2,3) .…”

“…One possible reason is that so-called deconditioning syndrome increases pain and reduces motor functions after surgery 2,3) . Actually, 22-70% HNP patients after surgery report sciatica and low back pain 4) which leads to restriction of movement inducing muscular atrophy, weakness, fatigue, and overload on discs of the lumbar spine.…”