A Systematic Review Within the Framework of the Cochrane Collaboration
Raymond W.J.G. Ostelo, PhD, PT, Henrica C.W. de Vet, PhD,
Gordon Waddell, DSc, FRCS, MD, Maria R. Kerckhoffs, MsC, PT, Pieter Leffers, MsC and Maurits van Tulder, PhD
Although several rehabilitation programs, physical fitness programs, or protocols regarding instruction for patients to return to work after lumbar disc surgery have been suggested, little is known about the efficacy of these treatments, and there are still persistent fears of causing reinjury, reherniation, or instability.
Three is no evidence that patients need to have their activities restricted after first-time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks postoperative) and no evidence they increase the reoperation rate.
The success rate of lumbar disc surgery varies from 60% to 90%.
In 2% to 19% of patients who undergo a first-time disc surgery, a recurrent herniated lumbar disc occurs and, in 74% of cases, occurs within 6 months after the patient’s first operation.1,2
In this systematic review, 13 studies were included. The qualitative analysis showed that there is no strong evidence for any treatment that starts immediately after surgery. For treatments that start 4 to 6 weeks postsurgery, there is strong evidence (level 1) that intensive exercise programs are more effective on functional status and faster return to work (short-term follow-up) and there is strong evidence (level 1) that on long-term follow-up, there is no difference between both interventions with regard to overall improvement.
Carragee, who concluded that lifting of postoperative restrictions after limited discectomy allowed shortened sick leave without increased complications.3
There is no evidence that patients need to have their activities restricted after first-time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks postsurgery) and no evidence they increase the reoperation rate.
- Cassisi JE, Robinson ME, O’Conner P, et al. Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low back pain. Spine 1993;18:245-51.
- Roy SH, CJ DL, Casavant DA. Lumbar muscle fatigue and chronic lower back pain. Spine 1989;14:992-1001.