The impact of spinal stabilization exercises on pain, disability, and physical functional after lumbar spinal fusion

Abstract

Lumbar spinal fusion (LSF) surgery is one of the most commonly performed procedures for degeneration of the lumbar spine. Though minimally invasive surgical techniques have been developed in an attempt to reduce muscle injury, some damage is unavoidable. Research on postoperative rehabilitation has not kept pace with the increased utilization of LSF in the United States over the past three decades, and there is a lack of high-quality evidence to answer questions regarding the optimal timing, duration, and type of rehabilitation to implement following surgery. Spinal stabilization exercises target the muscles that corset the lumbar spine to improve functional control of the trunk. Initiation of a spinal stabilization program early after LSF may reduce loss of muscle function, potentially improving clinical outcomes following surgery. The purpose of the three studies was to explore spinal surgeons’ perceptions of rehabilitation after LSF, investigate deep abdominal muscle performance during spinal stabilization exercises, and compare the effectiveness of early initiation of a spinal stabilization program to the current standard of care on outcomes after surgery. Spinal surgeons participated in one-on-one interviews to discuss their opinions on postoperative recovery. Data was assessed with content analysis, coding and triangulation. Findings indicated that surgeons prefer a rehabilitative program that includes cardiovascular activity, trunk stabilization exercises performed with the lumbar spine in a neutral position, and reinforcement of body mechanics. Next, five low-load, neutral spine stabilization exercises were tested with ultrasound imaging. Two one-way repeated measures ANOVAs were calculated to compare resting and contracted measurements of the transversus abdominis and internal oblique muscles. Results of this study were incorporated into a randomized, prospective clinical trial comparing the effects of early initiation of a spinal stabilization exercise program to standard of care after LSF. Participants randomized to the control group followed standardized guidelines for cardiovascular activity. Participants randomized to the intervention group received instruction in performance of a daily spinal stabilization exercise program. Four separate 2x3 mixed ANOVAs were used in data analysis. Results indicated that the program did not have either a positive or negative impact on pain, disability, or physical function up to six months postoperatively.