Manipulative rehabilitation applied soon after lumbar disc surgery improves late post-operative functional disability: A preliminary 2-year follow-up study

Osteopathic Manipulative Treatment During Post-operative Recovery: A Scoping Review

Surgery is a common and often necessary treatment option for a wide range of medical conditions, with an estimated 40 to 50 million surgeries performed in the US alone each year. While the various types of surgeries performed may be effective in treating or managing different conditions, the post-operative period can be challenging for patients. Osteopathic manipulative treatment (OMT) is a hands-on approach to medical care that seeks to restore balance and harmony to the body from the lens of an interconnected mind, body, and spirit. Given the potential for adverse events in patients following surgical treatments, OMT may be a viable adjunct post-operatively to enhance patient care and recovery. The purpose of this scoping review is to evaluate the state of current research examining the effectiveness of OMT in improving outcomes in post-operative patients. Three hundred articles were collected; 53 duplicates were removed. Eleven independent reviewers evaluated all 247 articles. Thirty articles were identified, including nine in general surgery, six in cardiothoracic surgery, five in orthopedic surgery, four in spinal surgery, three in neurosurgery, and three others (otolaryngology, oral/maxillofacial, and gynecologic surgery). Post-operative patients were treated with various OMT techniques with myofascial release and muscle energy being some of the most common treatments utilized in all surgical fields. Many studies demonstrated the benefits of OMT usage including significant pain relief, improved and earlier bowel function, and decreased lengths of hospital stay. This study demonstrates how OMT can be effective in reducing post-operative pain, reducing the incidence of post-operative ileus, and shortening the length of stay. Further research into the utilization of OMT in post-operative patients should be considered a potential adjunct to surgical intervention, especially in vulnerable patient populations.

Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis

BACKGROUND

The role of rehabilitation after surgery in patients with low back pain is well recognized. The aim of this systematic review is to summarize and update the existing evidence according to the type of clinical condition and rehabilitation approach.

METHODS

This systematic review included RCTs on the effectiveness of rehabilitation after surgery for lumbar disc herniation, spinal stenosis, and spondylolisthesis. We searched the literature for randomized controlled trials indexed in MEDLINE, Embase, CINHAL, CENTRAL, Scopus, PEDro, and Web of Science databases, up to April 15, 2023. We used Cochrane Risk of Bias 2.0 tool to assess each study. We conducted a quantitative synthesis when population, intervention, control, and outcome were sufficiently homogeneous; otherwise, we conducted a qualitative analysis.

RESULTS

Forty-five studies (3.036 subjects) were included and analyzed according to the population considered: lumbar stenosis (1 trial), spondylolisthesis (3 trials), and disc herniation (41 trials). Regarding lumbar stenosis, a supervised active exercise program appears to improve outcomes related to pain, disability, and quality of life both in the short- and mid-term (1 study, n = 60). Concerning spondylolisthesis, kinesiophobia is reduced in the home exercises group compared to usual care, at 3-months follow-up (3 studies, n = 98). For disk herniation, supervised exercises are better than non-supervised exercises to reduce pain (MD -1.14; 95% CIs -1.65, -0.62; 5 trials, n = 250) and disability (SMD -0.70; 95% CIs -1.14, -0.26; 4 trials, n = 175). Supervised exercises are better than advice in reducing pain (SMD -0.91; 95% CIs -1.61, -0.21; 5 trials, n = 341) and disability (SMD -0.80; 95% CIs -1.59, -0.01; 4 trials, n = 261), in the short-term. Supervised exercises are equal to no treatment in reducing pain and disability, at 3 and 6 months after intervention (2 trials, n = 166). These results are supported by a very low to low quality of evidence.

CONCLUSIONS

Our research suggests that supervised exercise may be effective in improving patient's pain and disability after lumbar surgery, but RCTs regarding lumbar spinal stenosis and lumbar spondylolisthesis are still scarce, with significant heterogeneity of proposed interventions.

Randomized controlled trial of overall functional exercise process in perioperative of percutaneous transforaminal endoscopic discectomy

BACKGROUND

Percutaneous transforaminal endoscopic discectomy (PTED) has become the standard surgery for the patients of lumbar disc herniation with the advantages of less trauma and rapid recovery. But still some patients have poor prognosis after PTED. A major risk factor associated with the poor prognosis may be the unfit function exercise.

OBJECTIVE

To discuss the effect of overall functional exercise process for PTED.

METHODS

In January 2019 to June 2020, a single center randomized controlled trial was proceeded. The patients scheduled for PTED were randomly divided into the experimental group, which received overall functional exercise and the control group, which received routine process. The overall process included advance, whole-course exercise and integrating of traditional Chinese medical methods. The general information, visual analog scale (VAS) score and Oswestry Dysfunction Index (ODI) score at each follow-up point perioperative period were compared between the 2 groups.

RESULTS

There were no significant differences in the general information, the preoperative VAS and ODI. On the 3rd day after operation, the VAS of low back pain and leg pain in the experimental group were lower than the control group. One month after operation, the VAS of low back pain in the experimental group was lower than that in the control group. One to 3 months after operation, the ODI scores of the experimental group were better than that of the control group. There was no significant difference in modified MacNab index between the experimental group and the control group.

CONCLUSION

Function exercise is important for the prognosis of minimally invasive lumbar surgery. The overall function exercise process perioperative is helpful to relieve the short-term pain of the patients and significantly improve the prognosis.

Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review

BACKGROUND AND PURPOSE

Pain and disability may persist following lumbar spine surgery and patients may subsequently seek providers trained in manipulative and manual therapy (MMT). This systematic review investigates the effectiveness of MMT after lumbar surgery through identifying, summarizing, assessing quality, and grading the strength of available evidence. Secondarily, we synthesized the impact on medication utilization, and reports on adverse events.

METHODS

Databases and grey literature were searched from inception through August 2020. Article extraction consisted of principal findings, pain and function/disability, medication consumption, and adverse events.

RESULTS

Literature search yielded 2025 articles,117 full-text articles were screened and 51 citations met inclusion criteria.

CONCLUSION

There is moderate evidence to recommend neural mobilization and myofascial release after lumbar fusion, but inconclusive evidence to recommend for or against most manual therapies after most surgical interventions. The literature is primarily limited to low-level studies. More high-quality studies are needed to make recommendations.

Relationship between straight leg-raising test measurements and area of fat infiltration in multifidus muscles in patients with lumbar disc hernation

BACKGROUND

A few studies have noted that paraspinal muscle training is important to reduce pain for patients with lumbar disc herniation (LDH). However, little is known about the exact signs for necessary training of lumbar multifidus muscles (LMM).

OBJECTIVE

The study aimed to analyze the relationship between the straight leg-raising test (SLR) and the area of fat infiltration in LMM for patients with LDH.

METHOD

One hundred and fourteen LDH patients were involved in this study. Clinical data were collected from a medical record system. On the MRI images, the cross-sectional areas (CSA) of bilateral fat infiltration in LMM were measured by picture archiving and communication system (PACS).

RESULT

For 61 patients with inclusive LDH, the positive side of SLR was positively correlated with the side of the larger total CSA of fat infiltration in LMM of L2-S1 (r= 0.75, p⁢ï⁢¼⁢ 0.01), and the CSA of fat infiltration on the side of SLR with a positive result was significantly larger than that on the side of SLR with a negative result only at L3-4 and L4-5 levels (p⁢ï⁢¼⁢ 0.01).

CONCLUSION

SLR may be used as an important sign for dysfunction of LMM and can identify the more severe side.

The Effectiveness and Safety of Utilizing Mobile Phone-Based Programs for Rehabilitation After Lumbar Spinal Surgery: Multicenter, Prospective Randomized Controlled Trial

Background

Rehabilitation is crucial for postoperative patients with low back pain (LBP). However, the implementation of traditional clinic-based programs is limited in developing countries, such as China, because of the maldistribution of medical resources. Mobile phone–based programs may be a potential substitute for those who have no access to traditional rehabilitation.

Objective

The aim of this study was to examine the efficacy of mobile phone–based rehabilitation systems in patients who underwent lumbar spinal surgery.

Methods

Patients who accepted spinal surgeries were recruited and randomized into 2 groups of rehabilitation treatments: (1) a mobile phone–based eHealth (electronic health) program (EH) or (2) usual care treatment (UC). The primary outcomes were (1) function and pain status assessed by the Oswestry Disability Index (ODI) and (2) the visual analog scale (VAS). Secondary outcomes were (1) general mental health and (2) quality of life (Likert scales, EuroQol-5 Dimension health questionnaire, and 36-item Short-Form Health Survey). All the patients were assessed preoperatively and then at 3, 6, 12, and 24 months postoperatively.

Results

A total of 168 of the 863 eligible patients were included and randomized in this study. Our analysis showed that the improvement of primary outcomes in the EH group was superior to the UC group at 24 months postoperatively (ODI mean 7.02, SD 3.10, P<.05; VAS mean 7.59, SD 3.42, P<.05). No significant difference of primary outcomes was found at other time points.

A subgroup analysis showed that the improvements of the primary outcomes were more significant in those who completed 6 or more training sessions each week throughout the trial (the highest compliance group) compared with the UC group at 6 months (ODI mean 17.94, SD 5.24, P<.05; VAS mean 19.56, SD 5.27, P<.05), 12 months (ODI mean 13.39, SD 5.32, P<.05; VAS mean 14.35, SD 5.23, P<.05), and 24 months (ODI mean 18.80, SD 5.22, P<.05; VAS mean 21.56, SD 5.28, P<.05).

Conclusions

This research demonstrated that a mobile phone–based telerehabilitation system is effective in self-managed rehabilitation for postoperative patients with LBP. The effectiveness of eHealth was more evident in participants with higher compliance. Future research should focus on improving patients’ compliance.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-TRC-13003314; http://www.chictr.org.cn/showproj.aspx?proj=6245 (Archived by WebCite at http://www.webcitation.org/766RAIDNc)