Is Active Rehab After Spinal Stenosis Surgery Effective?

A recent review article has been published looking at active rehabilitation as a tool to improve postoperative results from lumbar spinal stenosis surgery. Spinal stenosis is the narrowing of the spinal canal which can lead to pressure on the spinal cord or nerve roots, resulting in pain in the back and legs. This condition is usually caused by changes related to aging in the disc, lumbar vertebra, and supporting structures. Surgery to relieve this pressure accesses the spine through the back and then the excesses bone, thickened ligaments and degenerative disc tissue is removed to create space. This procedure has been increasingly common due to rising older population and over the age of sixty five spinal stenosis is the most common indication for spinal surgery. In the US Medicare system more than 37,000 decompression procedures were reported for 2007.

Although this surgery is becoming more common, there is quite a bit of variability reported in the outcomes, and many people do not regain good function following this procedure. Studies report functional improvements between fifty-eight and sixty-nine percent, and participant satisfaction ranges greatly from fifteen to eighty-one percent. Due to these suboptimal outcomes there is need for more research about how to improve upon the success rates. This review was undertaken to determine whether active rehabilitation; including education, exercise, behavioral training, neuromuscular training and stabilization training improved outcomes compared to “usual postoperative care.”

Several common databases were searched for randomized controlled trials that compared the effectiveness of active rehabilitation to that of usual care for adults who have undergone primary spinal decompression surgery. The searches resulted in three studies which fit all the criteria for this review. Usual care included limited advice about being active postoperatively to a brief routine of exercises focused primarily on prevention of deep vein thrombosis. Active rehabilitation included group or therapist led exercise programs focused on restoring or improving function. These programs included exercises for stabilization, muscle strengthening and flexibility as well as education about staying active. Success was measured with a disease-specific measures of functional or disability status (such as the Oswestry Disability Index), measures of global health (36-item Short Form Health Survey), and pain severity.

The evidence coming from these three studies indicates that there is moderate evidence to support that active rehabilitation is more effective than usual care. This is true for both short term and long term function and for low back pain. There is also moderate evidence at twelve months post operation that active rehab is more effective than usual care for improving leg pain. This particular study also mentions a few other studies which, although they did not fit the criteria to be included in these results, have also corroborated these findings, indicating that more research is needed in order to find out the timing and content of the rehab for the best outcomes. Some of these other studies also included pre-operative therapy, cognitive-behavioral therapy, and a back-cafe model (guided group exercise, education and support sessions), indicating that further research needs to be done on a more holistic approach including education and finding patient preferences to help improve outcomes for this increasingly common surgical procedure.