Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

  Is Therapeutic Exercise a Necessary Component of Surgical Interventions? Review of Post-Surgical Exercise for Lumbar Spine Care.   (#139)

Ram Haddas 1 , Andreas Remis 2 , Paul Rubery 1 , Kostantinos Vasalos 1 , Varun Puvanesarajah 1 , John Mayer 3
  1. University of Rochester Medical Center, Rochester, NY, United States
  2. Physical Therapy, Duke, Morrisville
  3. U.S. Spine & Sport Foundation, San Diego

Introduction: Low back pain is the leading worldwide cause of years lived with disability and poses a significant financial burden on patients and the health care system.1-2 Recurrence rates and surgical rates are increasing.3 Surgical indications include lumbar instability, cancer, infection, and acute neurologic deficits that are concordant with radiographic assessment and refractory to conservative management.4-5 Surgical decompression and fusion effectively improve pain and function when indicated. However, recurrent symptoms following surgery are common. Therapeutic exercise is a prescribed physical activity program involving voluntary muscle contractions and body movements that aim to improve symptoms and function and is an important aspect of post-operative care.5-7 Physical therapy following lumbar spine surgery can improve pain, disability, function, and opioid reliance through supervised therapeutic exercise to improve confidence, range of motion, strength, balance, and movement quality. Despite this, the level of high-quality evidence regarding physical therapy and therapeutic exercise parameters and protocols following spine surgery remains sparse, resulting in a wide variance in utilization.8-9 Therefore, the purpose of this study is to provide a review and recommendation on therapeutic exercise following spinal surgery.

Methods: A comprehensive review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE (Elsevier); and Scopus. Articles related to therapeutic exercise following lumbar spine surgery were selected. Extracted data was collected as per a predetermined checklist including exercise modalities, parameters, safety, and associated outcomes.

Results: Of the 2,986 publications initially screened, 147 were extensively analyzed and selected for retrieval. Ultimately, 129 publications were identified as suitable for inclusion based on the relevance of their content to the core objectives of this review. The most relevant studies were included, with a focus on therapeutic exercises that are safe to do following lumbar spine surgery.

Discussion: The findings of this review support therapeutic exercise as safe and beneficial following lumbar discectomy, fusion, and total disc arthroplasty. Early physical therapy reduces opioid use, disability, and pain, and appears more beneficial than independent programs. Clinicians must consider patient-related factors, surgery-related factors, and available evidence when prescribing therapeutic exercise. Initial exercise prescriptions should be modified according to the prior level of function and comorbidities to improve adherence and reduce complications. Physical literacy should be considered in determining the complexity and breadth of exercise prescriptions. Thoughts, feelings, and behaviors may interfere with engagement in appropriate amounts of therapeutic exercises, and therefore, should be screened for and addressed accordingly. Exercise programs focus on improving range of motion, muscle function, balance, and movement quality. Special considerations are needed for surgical factors, including mechanotherapy. Clinicians may use the available evidence in this review to counsel patients on specific therapeutic exercise parameters and long-term activity recommendations to optimize outcomes following lumbar spine surgery.

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