Effects of early regular rehabilitation on lumbar function and sagittal plane parameters in patients after lumbar fusion: a prospective randomized controlled study

English Keywords:Lumbar fusion  Functional exercise  Sagittal plane parameter of lumbar spine  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To explore the effects of early regular rehabilitation exercise on lumbar function and saggital plane parameters of patients after single-segment posterior lumbar interbody fusion surgery(PLIF). Methods: Using a prospective, contemporaneous, parallel, controlled study design, 124 patients who underwent single-segment PLIF for degenerative lumbar spine disease were randomly divided into a rehabilitation group and a control group, with 62 patients in each group. The rehabilitation group consisted of 30 males and 32 females, with a mean age of 54.0±4.8 years old; The control group included 29 males and 33 females, with a mean age of 55.0±5.2 years old. Patients in the rehabilitation group were instructed in regular functional training under the guidance of rehabilitation instructor, while patients in the control group performed functional exercise on their own. The preoperative, postoperative 1, 3, and 6 months′ Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score, and Barthel scale score were recorded. Drainage and hospitalization days were recorded, and lumbar lordosis(LL) angle and lumbar arch area(LAA) before operation and at postoperative 3 and 6 months were measured and compared between groups, perioperative complications were recorded, and finally a statistical analysis was performed to compare the differences in treatment effects between the two groups. Results: The ODI, JOA score and Barthel scale score of the rehabilitation group were better than those of the control group at 1 and 3 months after surgery, with statistical significance(P＜0.05). There were no significant differences in ODI, JOA score and Barthel score between the two groups at 6 months after operation(P>0.05). There was no statistical difference in the amount of drainage between the two groups(P＞0.05). The number of hospitalization days in the rehabilitation group was less than that in the control group (7.6±0.7d vs 9.7±0.6d, P<0.05). At 6 months postoperatively, the LL and LLA of patients in the rehabilitation group(51.3°±2.3° and 26.6±1.6mm2) were greater than those of patients in the control group(46.8°±4.2° and 21.5±3.1mm2), and the differences were statistically significant(P<0.05). As for early postoperative complications, one case of abdominal distension and constipation and one case of hematoma in the operation area were observed in the rehabilitation group; Six cases of abdominal distension, two cases of deep vein thrombosis, one case of lung infection and one case of urinary tract infection were observed in the control group. There was no statistical difference in complications between the two groups(P>0.05). Conclusions: After single-segment PLIF, early and regular rehabilitation training can shorten the length of hospital stays, reduce perioperative complications, and have a positive effect on the functional recovery and improvement of living ability of patients.