Can exercise therapy improve the outcome of microdiscectomy?

Study Design. A prospective randomized controlled trial of exercise therapy in patients who underwent microdiscectomy for prolapsed lumbar interverteb ral disc, Results of a pilot study are presented. Objective. To determine the effects of a postoperative exercise program on pain, disability, psychological status, and spinal function. Summary of Background Data. Microdiscectomy is of ten used successfully to treat prolapsed lumbar intervertebral disc. However, some patients do not h ave a good outcome and many continue to have low back pain. The reasons for this are unclear but impairment of back muscle unction due to months of in activity before surgery may be a contributing factor, A postoperative exerc ise program may improve outcome in such patients. Methods. Twenty patients who underwent lumbar microdiscectomy were randomiz ed into EXERCISE and CONTROL groups. After surgery, all patients received n ormal postoperative care that included advice from a physiotherapist about exercise and a return to normal activities. Six weeks after surgery, patien ts in the EXERCISE group undertook a 4-week exercise program that concentra ted on improving strength and endurance of the back and abdominal muscles a nd mobility of the spine and hips. Assessments of spinal function were perf ormed in all patients during the week before surgery and at 6, 10, 26, and 52 weeks after. The assessment included measures of posture, hip and lumbar mobility, back muscle endurance capacity and electromyographic measures of back muscle fatigue. On each occasion, patients completed questionnaires i nquiring about pain, disability and psychological status. Results. Surgery improved pain, disability, back muscle endurance capacity and hip and lumbar mobility in both groups of patients. After the exercise program, the EXERCISE group showed further improvements in these measures a nd also in electromyographic measures of back muscle fatigability, All thes e improvements were maintained 12 months after surgery, The only further im provement showed by the CONTROL group between 6 and 52 weeks was an increas e in back muscle endurance capacity. Conclusion. A 4-week postoperative exercise program can improve pain, disab ility, and spinal function in patients who undergo microdiscectomy.