Early Rehabilitation Program and Vitamin D Supplementation Improves Sensitivity of Balance and the Postural Control in Patients after Posterior Lumbar Interbody Fusion: A Randomized Trial.

Wojciech Skrobot,Witold Libionka,Jedrzej Antosiewicz,Jan J Kaczor,Ewelina Liedtke,Katarzyna P Dzik,Jakub Kortas,Katarzyna Krasowska,Wojciech Kloc,Damian J Flis,Anna Samoraj-Dereszkiewicz

doi:10.3390/nu11092202

Abstract

Background: The introduction of early rehabilitation exercise is the foundation of treatment post-Posterior lumbar interbody fusion (PLIF) surgery, and the search for additional sources of reinforcement physiotherapy seems to be very important. Methods: The patients were randomly divided into the vitamin D3 (n = 15; D3) supplemented group and received 3200 IU per day for five weeks before surgery and the placebo group (n = 18; Pl) received vegetable oil during the same time. The patients began the supervisor rehabilitation program four weeks after surgery. Results: The limits of stability (LOS) were significantly improved in the D3 group after 5 and 14 weeks (p < 0.05), while in the Pl group, progress was only observed after 14 weeks (p < 0.05). The LOS were also higher in the D3 group than in the Pl group after five weeks of supervised rehabilitation (p < 0.05). In the postural stability (PST) test, significant progress was observed in the D3 group after 14 weeks (p < 0.02). In addition, neither rehabilitation nor supplementation had significant effects on the risk of falls (RFT). Conclusions: Vitamin D supplementation seems to ameliorate the effects of an early postoperative rehabilitation program implemented four weeks after posterior lumbar interbody fusion. Early physiotherapy treatment after PLIF surgery combined with vitamin D supplementation appears to be a very important combination with regard to the patients’ recovery process.

Highlights

Proper and rapid bony fusion of the stabilized spinal segment in the patients who have undergone a posterior lumbar interbody fusion (PLIF) procedure is of the utmost importance regarding the clinical outcome of the surgery
The most important finding of this study was that the patients after Posterior lumbar interbody fusion (PLIF) surgery that had an early rehabilitation program and were supplemented with vitamin D3 appeared to have better short-term outcomes of the objective parameters, like body proprioception control when compared to the patients who only underwent the rehabilitation program
Our results indicated that early rehabilitation associated with vitamin D intake had beneficial effects with a faster return to balance, recovery, and better postural control after PLIF surgery

Summary

Introduction

Proper and rapid bony fusion of the stabilized spinal segment in the patients who have undergone a posterior lumbar interbody fusion (PLIF) procedure is of the utmost importance regarding the clinical outcome of the surgery. Rehabilitation is important in this group of patients as it has been reported that muscle damage and denervation is greater after PLIF, and a period of postoperative immobilization is longer when compared to a simple lumbar discectomy [2,3]. The introduction of early rehabilitation exercise is the foundation of treatment post-Posterior lumbar interbody fusion (PLIF) surgery, and the search for additional sources of reinforcement physiotherapy seems to be very important. Conclusions: Vitamin D supplementation seems to ameliorate the effects of an early postoperative rehabilitation program implemented four weeks after posterior lumbar interbody fusion. Physiotherapy treatment after PLIF surgery combined with vitamin D supplementation appears to be a very important combination with regard to the patients’ recovery process

Objectives

Results

Discussion

Conclusion