Rehabilitation after surgical treatment of lumbar disc herniation: Overview of clinical studies and suggestions of management

Introduction: In the scholarly literature, many examples of rehabilitation approaches following surgical treatment of discopathy can be found. However, little is known about the effectiveness of those methods assessed according to the standards of Evidence Based Medicine. Aim: The aim of this study was to analyse publications of experimental clinical studies including assessment of quality of the applied methodology and, based on this analysis, to evaluate the effectiveness of rehabilitation following surgical therapy of lumbar disc herniation. Material and methods: The analysis comprised clinical studies with and without randomisation and case-control clinical studies on rehabilitation therapy after surgery due to lumbar disc herniation. The overview was conducted using the following databases: MEDLINE, EMBASE, PEDro, Cochrane Database, CEBP and comprised the period of time from 1985 to 2006. Results: Nineteen publications were finally included in the analysis; 10 of them were randomised clinical trials of high methodological quality, 7 were randomised clinical trials of low methodological quality, and 2 reports of case-control, non-randomised studies. Conclusions: So far, there is no strong scientific evidence confirming the efficacy of rehabilitation initiated immediately following surgery. There is strong evidence confirming high effectiveness of intensive rehabilitation exercises initiated in the 4th – 6th week following surgery that improve mobility, stabilise the spine and strengthen back muscles. Intensive rehabilitation, as compared to the traditional or less intensive rehabilitation and to the lack of rehabilitation (moderate scientific evidence), significantly improves patients’ quality of life, ameliorates functioning, reduces pain and thus accelerates patients’ return to work. However, there are no scientifically confirmed guidelines as to which types of exercises should be recommended.