Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review

Hainan Yu^{1

2

3}, Carol Cancelliere^{1

2}, Silvano Mior^{1

2

4

5}, Paulo Pereira^{6

7}, Margareta Nordin⁸, Ginny Brunton^{1

2}, Jessica J Wong^{1

2

9

5}, Heather M Shearer^{1

2

10}, Gaelan Connell^{1

2}, Lauren Ead^{2

9

5}, Leslie Verville^{1

2}, Mana Rezai^{1

2}, Danny Myrtos¹¹, Dan Wang^{1

2}, Andrée-Anne Marchand¹², Andrew Romanelli¹¹, Darrin Germann¹¹, Daphne To¹¹, James J Young^{13

14}, Danielle Southerst^{1

2}, Henry Candelaria¹⁵, Sheilah Hogg-Johnson^{2

4

16

5}, Pierre Côté^{1

2

16

5}

Affiliations

¹ Faculty of Health Sciences, Ontario Tech University, Canada.
² Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada.
³ Undergraduate Education, Canadian Memorial Chiropractic College, Canada.
⁴ Research and Innovation, Canadian Memorial Chiropractic College, Canada.
⁵ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁶ Faculty of Medicine, University of Porto, Portugal.
⁷ Department of Neurosurgery - Centro Hospitalar Universitário S. João, Porto, Portugal.
⁸ Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY, USA.
⁹ Division of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
¹⁰ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada.
¹¹ Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada.
¹² Department of Chiropractic, Université du Québec à Trois-Rivières, Canada.
¹³ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
¹⁴ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
¹⁵ Rapid Access Clinic for Low Back Pain, Trillium Health Partners, Mississauga, Ontario, Canada.
¹⁶ Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada.

PMID: 38690091
PMCID: PMC11059472
DOI: 10.1016/j.bas.2024.102806

Review

Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review

Hainan Yu et al. Brain Spine. 2024.

. 2024 Apr 16:4:102806.

doi: 10.1016/j.bas.2024.102806. eCollection 2024.

Authors

Affiliations

¹ Faculty of Health Sciences, Ontario Tech University, Canada.
² Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada.
³ Undergraduate Education, Canadian Memorial Chiropractic College, Canada.
⁴ Research and Innovation, Canadian Memorial Chiropractic College, Canada.
⁵ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁶ Faculty of Medicine, University of Porto, Portugal.
⁷ Department of Neurosurgery - Centro Hospitalar Universitário S. João, Porto, Portugal.
⁸ Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY, USA.
⁹ Division of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
¹⁰ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada.
¹¹ Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada.
¹² Department of Chiropractic, Université du Québec à Trois-Rivières, Canada.
¹³ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
¹⁴ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
¹⁵ Rapid Access Clinic for Low Back Pain, Trillium Health Partners, Mississauga, Ontario, Canada.
¹⁶ Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada.

PMID: 38690091
PMCID: PMC11059472
DOI: 10.1016/j.bas.2024.102806

Abstract

Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear.

Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH.

Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach.

Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events.

Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

Keywords: Disc herniation; Enhanced postsurgical recovery; Rehabilitation; Systematic review.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Carol Cacelliere reports financial support was provided by 10.13039/501100011713EUROSPINE Task Force on Research. Carol Cancelliere reports financial support was provided by Canadian Chiropractic Research Foundation. Andree-Anne Marchand reports a relationship with Canadian Chiropractic Research Foundation that includes: funding grants. Andree-Anne Marchand reports a relationship with Fondation régionale pour la santé de Trois-Rivières that includes: funding grants. Dan Wang reports a relationship with Canadian Chiropractic Research Foundation that includes: funding grants. Dan Wang reports a relationship with Fondation régionale pour la santé de Trois-Rivières that includes: funding grants. Jessica Wong reports a relationship with Canadian Chiropractic Research Foundation that includes: funding grants. Jessica Wong reports a relationship with 10.13039/501100000024Canadian Institutes of Health Research (10.13039/501100000024CIHR) that includes: funding grants. James Young reports a relationship with 10.13039/501100000142Arthritis Society Canada (22–0000000058) that includes: funding grants. James Young reports a relationship with Diana Kerbel Fellowship in Arthritis Integrated Care that includes: funding grants. James Young reports a relationship with Danish Foundation for Chiropractic Research and Post-graduate Education that includes: funding grants. James Young reports a relationship with 10.13039/501100000024Canadian Institutes of Health Research Clinical Trials Fund that includes: funding grants. Margareta Nordin reports a relationship with Canadian Chiropractic Research Foundation that includes: funding grants. Margareta Nordin reports a relationship with Canadian Institute of 10.13039/100005622Health Research that includes: funding grants. Pierre Cote reports a relationship with Canada Research Chair Program that includes: funding grants. Pierre Cote reports a relationship with EUROSPINE that includes: speaking and lecture fees. Pierre Cote reports a relationship with Canadian Protective Chiropractic Association that includes: paid expert testimony. Sheilah Hogg-Johnson reports a relationship with Canadian Memorial Chiropractic College that includes: employment. Silvano Mior reports a relationship with Canadian Chiropractic Association that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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Identification and selection of articles.

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References

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Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review

Affiliations

Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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