Rehabilitation following surgery for lumbar spinal stenosis. A Cochrane review.
McGregor AH., Probyn K., Cro S., Doré CJ., Burton AK., Balagué F., Pincus T., Fairbank J.
STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the effects of active rehabilitation on functional outcome after lumbar spinal stenosis surgery when compared with "usual postoperative care." SUMMARY OF BACKGROUND DATA: Surgery rates for lumbar spinal stenosis have risen, yet outcomes remain suboptimal. Postoperative rehabilitation has been suggested as a tool to improve postoperative function but, to date, there is limited evidence to support its use. METHODS: CENTRAL (The Cochrane Library), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL, and PEDro electronic databases were searched. Randomized controlled trials comparing the effectiveness of active rehabilitation with usual care in adults with lumbar spinal stenosis who had undergone primary spinal decompression surgery were included. Two authors independently selected studies, assessed the risk of bias, and extracted the data in line with the recommendations of the Cochrane Back Review Group. Study results were pooled in a meta-analysis when appropriate using functional status as the primary outcome, with secondary outcomes including measures of leg pain, low back pain, and global improvement/general health. The GRADE approach was used to assess the quality of the evidence. RESULTS: Our searches yielded 1726 articles, of which 3 studies (N = 373 participants) were suitable for inclusion in meta-analysis. All included studies were deemed to have low risk of bias; no study had unacceptably high dropout rates. There was moderate evidence suggesting that active rehabilitation was more effective than usual care in improving both short- and long-term functional status after surgery. Similar findings were noted for secondary outcomes, including short-term improvement in low back pain and long-term improvement in both low back pain and leg pain. CONCLUSION: We obtained moderate-quality evidence indicating that postoperative active rehabilitation after decompression surgery for lumbar spinal stenosis is more effective than usual care. Further work is required particularly with respect to the cost-effectiveness of such interventions. LEVEL OF EVIDENCE: 1.