Physiotherapeutic Rehabilitation Following Lumbar Total Disc Replacement

This study aimed to answer the questions of what are the outcomes of physiotherapy post lumbar total disc replacement (LTDR) compared with patient self-mediated rehabilitation and is a difference in outcomes related to the number of physiotherapy sessions? This is a retrospective observational study of 600 patients post TDR. Patient outcomes for self-mediated rehabilitation (Group 1), 1-3 sessions of clinic-based physiotherapy (Group 2) and ≥4 sessions of clinic-based physiotherapy (Group 3) were analysed. Outcomes measures included the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), Short Form-36 Physical (SF-36 PCS) and Mental Subscale Components (SF-36 MCS), Visual Analogue Scale (VAS) for back and leg pain intensity. Particpant’s pre-operative baseline measures and post-operative follow-up measures at 3, 6, 12 and 24 months post-operatively were analysed. Oswestry Disability Index and RMQ had significantly decreased scores in Group 3 compared with Group 1 at 3, 6, 12 and 24 months follow-up. Significantly reduced scores for Group 2 compared with Group 1 were observed for the ODI at 3 months follow-up and for the RMQ at 3 and 6 months follow-up. Significantly lower scores were observed in Group 3 compared with Group 1 for VAS back pain at 3 months and VAS leg pain at 6 month follow-up. Significantly higher scores in Group 3 compared with Group 1 were also seen in the SF-36 PCS at 6, 12 and 24 months. Significantly higher scores in Group 2 compared with Group 1 were observed at 6 months follow up. These trends were also observed when investigating the percentage of patients with a greater 50% improvement in the outcome measure.

Physiotherapy post-LTDR produced statistically significant and possibly clinically important improvements in functional disability, pain and quality of life outcomes in comparison to self-mediated rehabilitation.

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