Evaluation and Rehabilitation after Adult Lumbar Spine Surgery

Abstract

Purpose: With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. Materials and Methods: The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Results: Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Conclusions: Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.

Keywords: lumbar surgery; muscle exercise; physiotherapy; rehabilitation.

Figure 4

Walk velocity.

Figure 5

6-min walk test.

Figure 6

Timed up and go test.

Figure 7

Functional reach test.

Figure 8

The principle of accelerometer.

Figure 11

Functional neutral spine control exercises, (A): Drow-in [115,116], (B): Bird dog exercise, (C): Clam shell exercise, (D): Bilateral shoulder extension, (E): Bilateral shoulder flexion, (F): Hip abduction.

Figure A1

Roland-Morris Disability Questionnaire (RMDQ).

Figure A2

Oswestry Disability Index (ODI).

Figure 1

Williams lumbar flexion exercises, (A): Pelvic tilt (B): Sit-up in knee flexion (C): Double knees to chest to stretch the elector spine, (D): Seated reach to toes stretches the hamstrings and elector spine, (E): Forward crouch to stretch iliofemoral ligament (F): Seated flexion (G,H): Strengthening of quadriceps muscles and stretching of gluteus maximus and elector spine.

Figure 2

McKenzie exercises, (A): Flexion in standing (B): Extension in standing (C): Flexion in lying, (D): Therapist-assisted side glide in standing (E): Side glide in standing (F): Extension in lying.

Figure 3

Interpretation of changes in post-treatment evaluation results, A: Post-treatment evaluation results are measurement error and clinically not important, B: The post-treatment assessment results showed changes beyond the measurement error, but not clinically important changes, C: The results of the post-treatment evaluation show clinically important changes.

Figure 9

The path of entry for different spinal fusion techniques.

Figure 10

Oblique lumbar interbody fusion (OLIF) approach.

Figure 12

Effect of iliopsoas muscle in three positions.

Figure 13

Iliopsoas muscle exercise, (A): Hip flexion exercise in sitting position, (B): Wall standing exercise.

Figure 14

Dual- and multi-task balance exercise, (A): Walk while trying not to drop the ball on the tray (B): Stand on balance cushions with eyes closed, (C): Catch the ball while standing on the balance cushion, (D): Slalom walking with additional cognitive tasks.

Figure 15

Self-help devices and coaching of ADL, (A): Getting up from a lateral position, (B): Picking up things from the floor, (C): How to pick up objects from the floor using self-help tools, (D): How to put on pants using a trouser aid, (E): How to put on pants using a trouser aid, (F): How to put on shoes using a shoehorn.

Figure 16

The restricted exercise, (A): Lifting both legs in the supine position, (B): Lifting of the pelvis in the supine position, (C): Outstretching one arm with or without simultaneously outstretching of the contralateral leg in the all-fours position, (D): Arching of the back in the all-fours position.