Is it possible to obtain consensus on the tactics of early rehabilitation period after lumbar microdisCectomy?
https://doi.org/10.14531/ss2020.2.43-48
Abstract
Objective. To analyze distinctions in multidisciplinary approaches with respect to the timing of patients returning to daily physical activity after uncomplicated lumbar microdisectomy and to the readiness of doctors of various specialties to work according consensus guidelines.
Material and Methods. A written questionnaire survey of 60 specialists (20 neurosurgeons, 28 neurologists and 12 rehabilitologists) involved in the management of patients during the first six months after uncomplicated lumbar microdisectomy was conducted. The questionnaire included 12 questions with several answer options on the timing of returning to daily physical activity, and on the need to provide patients with written recommendations on limitations in motion regimen, physical work, sexual activity, and bracing.
Results. Significant dissonance both between doctors of the same specialty and of different specialties was demonstrated in the tactics of postoperative management of patients regarding the recommended terms for returning to daily activity. All respondents found it useful to create unified written recommendations on the motion regime, 90 % of specialists are ready to use the proposed recommendations after some modification. There was a slight increase in the recommended timing for return to daily physical activity compared with the recommendations of doctors in other countries.
Conclusion. The demonstrated interdisciplinary differences in the treatment, rehabilitation and timing of physical activity restriction for patients after lumbar microdisectomy require unification of the tactics of postoperative management.
About the Authors
N. I. TursynovKazakhstan
Nurtas Isataevich Tursynov, DMSci, associate professor of the Department of Neurology, Neurosurgery, Psychiatry and Rehabilitation
40 Gogol str., Karaganda, M01K6T3
M. A. Grigolashvili
Kazakhstan
Marina Archilovna Grigolashvili, MD, PhD, Head of the Department of Neurology, Neurosurgery, Psychiatry and Rehabilitation
40 Gogol str., Karaganda, M01K6T3
N. I. Sheveleva
Kazakhstan
Naila Igorevna Sheveleva, DMSci, Professor of the Department of Neurology, Neurosurgery, Psychiatry and Rehabilitation
40 Gogol str., Karaganda, M01K6T3
Sh. S. Muratbekova
Kazakhstan
Shynar Sabitovna Muratbekova, teaching assistant of the Department of Neurology, Neurosurgery, Psychiatry and Rehabilitation
40 Gogol str., Karaganda, M01K6T3
References
1. Oosterhuis T, Costa LO, Maher CG, de Vet HC, van Tulder MW, Ostelo RW.Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev. 2014;(3):CD003007. DOI: 10.1002/14651858.CD003007.
2. Gibson JN, Waddell G.Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. 2005;(2):CD001352. DOI: 10.1002/14651858.CD001352.
3. McGregor AH, Dicken B, Jamrozik K. National audit of post-operative management in spinal surgery. BMC Musculoskelet Disord. 2006;7:47. DOI: 10.1186/1471-2474-7-47.
4. Daly CD, Lim KZ, Ghosh P, Goldschlager T.Perioperative care for lumbar microdiscectomy: a survey of Australasian neurosurgeons. J Spine Surg. 2018;4:1–8. DOI: 10.21037/jss.2018.01.03.
5. Zoia C, Bongetta D, Poli JC, Verlotta M, Pugliese R, Gaetani P.Intraregional differences of perioperative management strategy for lumbar disc herniation: is the Devil really in the details? Int J Spine Surg. 2017;11:1. DOI: 10.14444/4001.
6. Kashcheev AA, Gushcha AO, Arestov SO. General principles for the treatment and rehabilitation of patients after surgery for degenerative-dystrophic lesions of the lumbosacral spine. RMJ. 2012;31:1548–1551. In Russian.
7. Muratbekova ShS, Sheveleva NI, Tursynov NI. Recommendations for patients in the early recovery period after microdisectomy in the lumbar spine. Certificate on entering information into the State Register of Rights to Objects Protected by Copyright of the Republic of Kazakhstan No. 3615 dated May 27, 2019. In Russian.
8. Rushton A, Wright C, Goodwin P, Calvert M, Freemantle N.Physiotherapy rehabilitation post first lumbar discectomy: a systematic review and meta-analysis of randomised controlled trials. Spine. 2011;36:E961–E972. DOI: 10.1097/BRS.0b013e3181f0e8f8.
9. Goodwin PC, Wright CC, Allan C, Crowther L, Darley C, Heap A, Paul E, White L, Rushton A.Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study. BMJ Open. 2015;5:e006069. DOI: 10.1136/bmjopen-2014-006069.
10. Kjellby-Wendt G, Styf J, Carlsson SG.Early active rehabilitation after surgery for lumbar disc herniation: a prospective, randomised study of psychometric assessment in 50 patients. Acta Orthop Scand. 2001;72:518–524. DOI: 10.1080/000164701753532871.
11. Kjellby-Wendt G, Carlsson SG, Styf J.Results of early active rehabilitation 5–7 years after surgical treatment for lumbar disc herniation. J Spinal Disord Tech. 2002;15:404– 409. DOI: 10,1097/00024720-200210000-00010.
12. Pope MH, Magnusson ML, Wilder DG, Goel VK, Spratt K.Is there a rational basis for post-surgical lifting restrictions? 2. Possible scientific approach. Eur Spine J. 1999;8:179–186. DOI: 10.1007/s005860050154.
13. Christensen FB, Laurberg I, Bunger CE.Importance of the back-cafҚconcept to rehabilitation after lumbar spinal fusion: a randomised clinical study with a 2 year follow up. Spine. 2003;28:2561–2569. DOI: 10.1097/01.BRS.0000097890.96524.A1
Review
For citations:
Tursynov N.I., Grigolashvili M.A., Sheveleva N.I., Muratbekova Sh.S. Is it possible to obtain consensus on the tactics of early rehabilitation period after lumbar microdisCectomy? Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(2):43-48. https://doi.org/10.14531/ss2020.2.43-48