A rehabilitation protocol for patients with lumbar degenerative disk disease treated with lumbar total disk replacement

Objectives: To evaluate the efficacy of the rehabilitation protocol designed by the Physical Medicine and Rehabilitation Department on the patients with lumbar degenerative disk disease after lumbar disk replacement surgery.

Design: Open prospective auto-controlled trial.

Setting: Physical medicine and rehabilitation department, neurosurgery department, and anesthesiology and pain management department.

Participants: Patients (N=20) with single level lumbar degenerative disk disease were recruited for this study.

Interventions: Lumbar disk prosthesis surgery with metal on metal lumbar disk prosthesis; preoperative, provocative, diskography; and a postoperative rehabilitation program were used.

Main outcome measures: Change in the functional status and pain intensity in patients was evaluated by the Oswestry Disability Index (ODI) and visual analog scale (VAS) during rest and movement. The ODI and VAS during rest and movement were primary outcome criteria, while return to work and duration of hospital stay were secondary outcome criteria. The results for the various scoring systems were statistically analyzed using the t test.

Results: Preoperative mean VAS scores ± SD at rest and movement were initially in the range of 6.00±2.47 and 8.65±1.08, respectively. The scores decreased to 1.70±1.12 and 2.60±1.72 at 3 months postsurgery, respectively (P<0.01). The scores decreased to 1.20±0.69 and 1.90±1.07 at 12 months postsurgery, respectively (P<0.01). The mean preoperative ODI score was 73.3±15.5; the postoperative scores were 35.0±15.5 and 20.4±12.9 at 3 and 12 months, respectively (P<0.01). The mean duration of hospital stay ± SD was 3.5±1.6 days, and return to work was achieved after a mean ± SD period of 14.1± 4.3 days with no complications related to surgery or the rehabilitation protocol.

Conclusions: The protocol was designed for postoperative rehabilitation program after artificial lumbar disk replacement surgery for degenerative disk disease patients. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and presented rehabilitation program. These parameters provide early pain relief and return to activities of daily living after surgery.