Clinical significance of early functional rehabilitation after posterior single-segment lumbar interbody fusion procedures

English Keywords:Lumbar fusion  Early rehabilitation  Enhanced recovery after surgery  Complication

English Abstract:

  【Abstract】 Objectives: To explore the effect of early functional rehabilitation after single-segment posterior lumbar interbody fusion(PLIF) on functional recovery and complications of patients. Methods: Patients with lumbar degenerative disease undergoing single-segment PLIF were divided into two groups. Patients in the early rehabilitation group were discharged from the bed under the protection of the lumbar spine on the first day postoperatively, and the catheter was removed. The drainage was changed to the normal pressure fromnegative pressure drainage bag, and the early functional exercise was guided by the rehabilitation therapist. The control group took rest in bed postoperatively, maintained negative pressure drainage, and the autonomous function exercise was performed after the urinary tube was removed. The operation time, intraoperative blood loss, postoperative extubation time and total drainage volume, lumbar Oswestry disability index(ODI) score, pain visual analogue scale(VAS) score and perioperative complications preoperative, and 1 month, 3 months, 6 months and 1 year perioperatively were recorded. Results: A total of 113 single-segment PLIF cases were included in the study. All patients underwent conventional rehabilitation measures before June 2017, and were included in the control group. All patients underwent early rehabilitation and were included in the early rehabilitation group. In the early rehabilitation group, there were 52 patients with female accounted for 61.5%(32 patients), the average age was 52.4±15.9 years(range: 23-78 years). In the control group, 61 patients had an average age of 55.0±11.2 years(range, 21-76 years), and female patients accounted for 54.1%(33 cases). There were no statistically significant differences in operation time between the two groups(118.79min vs 117.77min, P<0.05) and intraoperative blood loss(306.56ml vs 307.73ml, P<0.05). There were no significant differences in extubation time(3.00d vs 3.15d) and total drainage volume(390.77ml vs 374.75ml) between the two groups(P>0.05). There was no significant difference in the ODI and VAS scores between the 1 month, 3 months and 6 months, and 1-year follow-up(P>0.05). In the early rehabilitation group, there were 1 case with reoperation, 1 postoperative abdominal distension constipation, there were 2 cases had lower extremity venous thrombosis, 2 cases had urinary tract infection, and 4 cases had abdominal distension constipation in the control group. The difference in the bedridden related complication rate between the two groups was statistically significant(3.8% vs 13.1%, P<0.05). The average length of hospital stay was(8.7±3.2d vs 10.2±2.7d, P<0.01), and the difference was statistically significant.　Conclusions: Functional exercise under the guidance of a rehabilitation therapist in the early stage after single level PLIF procedure can reduce the risk of perioperative complications, and has no significant effect on total drainage, extubation time, functional rehabilitation and pain improvement.