- One year after lumbar discectomy, the outcomes of patients who had two weeks of postoperative activity restriction were comparable to those of patients who had six weeks of restriction
- Extended follow-up in about half of subjects (two years) confirmed the one-year findings
- No data from this study suggest that early return to full activity is superior to delayed return
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Restrictions on bending, lifting and twisting are common after lumbar discectomy, typically for six weeks. However, no strong consensus on how to choose the length of activity restriction. Some patients have rapid improvement while others have financial pressure to return to physical work before full recovery. Furthermore, delayed muscle rehabilitation might compromise outcomes.
In the first randomized, controlled trial to compare different post-operative protocols, Massachusetts General Hospital surgeons Thomas D. Cha, MD, MBA, assistant chief of the Orthopaedic Spine Center, Joseph H. Schwab, MD, and colleagues found that disability and pain after discectomy were similar whether activity was limited for two weeks or six weeks. The results of the study were published in the European Spine Journal.
The researchers recruited 112 adults who underwent discectomy because of predominant radicular leg pain correlating to a single-level, central or posterolateral lumbar disk herniation identified by CT myelogram or MRI. In all cases, the surgeon performed fragmentectomy without aggressive disk space curettage. Surgical wound closure was based on the surgeon’s preference, and no attempt was made to suture or otherwise address annular defects.
Before surgery, patients rated their back pain and leg pain on visual analog scales, and completed the modified Oswestry Disability Index. They rated their pain and disability again at two weeks, six weeks, three months and one year after surgery. For all patients, the researchers evaluated compliance with restrictions on activity at two weeks and six weeks. The original plan was to end data collection at one year, but every effort was made to follow patients for two years.
Data were collected on 98 patients (91%) at two weeks, 82 (76%) at six weeks, 81 (75%) at three months, 68 (63%) at one year and 58 (54%) at two years. At no time point was any significant difference detected between the two- and six-week restriction groups in terms of disability, back pain or leg pain. There also was no significant difference between groups for rates of recurrent disk herniation, but the study was not adequately designed to conclusively draw that outcome.
The researchers comment that surgeons and patients need to balance the benefits of early return to activity with the risk of reherniation. If patients are believed to be at high risk, then they can feel assured that about six weeks of activity restriction is unlikely to interfere with good outcomes. On the other hand, patients deemed to be at low risk of reherniation can feel confident that early return to activity at two weeks will not compromise their recovery.
Notably, about half of the patients in each activity restriction group were white. Other research has suggested that race affects outcomes after spine surgery, so the authors say the study findings might not be generalizable to patients of other races.
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