Abstract
BackgroundThere is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial.MethodsWe conducted a survey of current post-operative practice amongst spinal surgeons in the United Kingdom in 2002 to determine whether such interventions are being included routinely in the post-operative management of spinal patients.The survey included all surgeons who were members of either the British Association of Spinal Surgeons (BASS) or the Society for Back Pain Research. Data on the characteristics of each surgeon and his or her current pattern of practice and post-operative care were collected via a reply-paid postal questionnaire.ResultsUsable responses were provided by 57% of the 89 surgeons included in the survey. Most surgeons (79%) had a routine post-operative management regime, but only 35% had a written set of instructions that they gave to their patients concerning this. Over half (55%) of surgeons do not send their patients for any physiotherapy after discharge, with an average of less than two sessions of treatment organised by those that refer for physiotherapy at all. Restrictions on lifting, sitting and driving showed considerable inconsistency both between surgeons and also within the recommendations given by individual surgeons.ConclusionDemonstrable inconsistencies within and between spinal surgeons in their approaches to post-operative management can be interpreted as evidence of continuing and significant uncertainty across the sub-speciality as to what does constitute best care in these areas of practice. Conducting further large, rigorous, randomised controlled trials would be the best method for obtaining definitive answers to these questions.
Highlights
There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial
The existing literature supports the use of surgical intervention in the management of nerve root stenosis and disc protrusion [4,5,6,7,8,9]
BMC Musculoskeletal Disorders 2006, 7:47 http://www.biomedcentral.com/1471-2474/7/47 varying proportions of patients experiencing recurrent low back and leg pain or other impairment post-operatively, optimising the outcome of spinal surgery appears to be a priority for further research. [5,8,10]
Summary
There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial. Whilst low back pain (LBP) affects 60–80% of the population at some point in their lives [1], only 0.5% undergo surgical intervention [2]. This inpatient treatment forms the largest single component of overall expenditure related to LBP within the NHS [3]. BMC Musculoskeletal Disorders 2006, 7:47 http://www.biomedcentral.com/1471-2474/7/47 varying proportions of patients experiencing recurrent low back and leg pain or other impairment post-operatively, optimising the outcome of spinal surgery appears to be a priority for further research. Since many patients have structural abnormalities in their back muscles and poor levels of function [11,12,13,14,15,16] at the time of surgery, which can be compromised further by the surgery itself [17], improving post-operative care in terms of advice and rehabilitation potentially is an important area to consider
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