Activity restrictions after posterior lumbar discectomy - A prospective study of outcomes in 152 cases with no postoperative restrictions

Study Design. A prospective clinical trial was conducted. Objectives. To determine the feasibility of removing activity restrictions after surgery and encouraging early return to work; to ascertain the clinic al and behavioral response to such a strategy; and to identify factors pred ictive of early return to work, preparatory to possible randomized clinical trials. Summary of Background Information, Current practice usually entails several weeks to several months of restricted activities after lumbar discectomy t o avoid disc "reinjury" Earlier work has suggested these restrictions may n ot be necessary. Methods. One hundred fifty-two consecutive working patients undergoing limi ted open discectomy for herniated lumbar intervertebral disc were treated p ostoperatively with no activity restrictions. Patients were encouraged to r eturn to full activities as soon as possible. The patients were followed fo r a minimum of 2 years (average follow-up time = 4.8 years). At follow-up, an independent examiner evaluated each patient and collected further postop erative data. Results. One hundred forty-nine of the 152 patients (98%) returned to work. The average work loss was 1.2 weeks and 148 of 149 patients had returned t o full duty by 8 weeks. Approximately one-third of the group returned to wo rk within 1 week of surgery (32%), many the next day. Statistical analysis demostrated very early return to work did not correlate with either recurre nt sciatica, reoperation for reherniation, or ultimate clinical outcome. Se venteen patients (11.2%) had possible reherniations (recurrent sciatica) an d eight underwent reoperation (5.3%). Conclusion. Lifting of postoperative activity restrictions after limited di scectomy allowed shortened time to return to work relative to the 4 to 16 w eeks commonly recommended. Complication rates appear comparable to those re ported in the literature for patients under postoperative restrictions. Pos toperative restrictions may not be necessary in most patients.