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Rehabilitation shows no impact on outcomes after spinal stenosis surgery
The results mirror those of a previous study investigating rehab after decompression surgery.
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Postoperative rehabilitation provides no additional benefit after spinal stenosis surgery, according to the results of a 2-year comparison study conducted by Finnish investigators.
“Our conclusion is that the surgery itself relieved the symptoms in both groups, but the postoperative rehabilitation did not improve the surgical outcome,” Olavi Airaksinen, MD, PhD, said during his presentation at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine (ISSLS).
Randomized study
Airaksinen and his colleagues from Kuopio University Hospital in Finland studied 102 patients with pain and radiographic evidence of lumbar spinal stenosis who had unsuccessful conservative treatment and underwent spinal surgery at the hospital. The investigators excluded patients from the study who had an emergency or urgent spinal operation and those who had a cognitive impairment which prevented them from participating in the study or completing questionnaires. The patients included in the study had a mean age of 62 years.
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The investigators randomized 52 patients into a control group — who were told to “keep active” postoperatively — while 50 patients were randomized to a postoperative physiotherapy group.
Patients in the physiotherapy group started their rehabilitation program at 3 months postoperatively and received 1.5 hours of physiotherapy once a week for 12 weeks. The group also repeated this intervention at 12 months postoperatively. During the sessions, patients were supervised by a physiotherapist and performed stretching and activation exercises for their hip, thigh, lumbar and abdominal muscles. In addition, the group was instructed to perform at-home stretching and activation exercises once a day, three to four times per week.
The investigators evaluated the groups using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and treadmill test preoperatively and at 3, 12 and 24 months postoperatively.
Age
The investigators discovered no statistically significant differences between the groups at the 2-year follow-up regarding the VAS, ODI or treadmill test scores. Airaksinen noted that the findings were in line with those of a previous study that found no significant differences between patients who had postoperative rehabilitation after decompression surgery and those who did not.
During the paper discussion, an audience member noted that other studies have found that rehabilitation has had an effect on patients who underwent surgery for herniated discs and asked Airaksinen why his study had different findings.
Airaksinen said patients who undergo surgery for disc herniation are typically younger than those who have spinal stenosis surgery. Although he postulated that age may have been a factor for this difference, he noted that his investigation did not include a subgroup analysis based on age.
For more information:
- Olavi Airaksinen, MD, PhD, can be reached at the Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio University, FIN 70210 Kuopio, Finland; +358-17-173450; e-mail: olavi.airaksinen@kuh.fi. He has no direct financial interest in any product or company mentioned in this article.
Reference:
- Aalto T, Leinonen V, Kröger H, et al. Postoperative rehabilitation after spinal stenosis surgery — no effect on outcome in 2-year follow-up. Paper #52. Presented at the 36th Annual Meeting of the International Society of the Study of the Lumbar Spine. May 4-8, 2009. Miami.