Rehabilitation of patients after microdiscectomy on the lumbar spine

Today, surgical methods for treating degenerative spinal diseases are widely used and actively applied all over the world. Traditionally, more than 80 % of degenerative changes are localized in the lumbar region, and more than 60 % of them are associated with intervertebral disc damage. Aim. Is to show the effectiveness of rehabilitation measures by analyzing their relationship with surgical interventions such as microdiscectomy at the lumbar level. Methods. This study conducted a retrospective quantitative analysis of surgical interventions performed in the neurosurgery department of the State Budgetary Healthcare Institution of the Astrakhan Region, the Alexandro-Mariinskaya Regional Clinical Hospital in 2024. The rehabilitation treatment was analyzed based on the results of the rehabilitation center of the Tinaki Pension and Social Insurance Fund in Astrakhan. Results. In 171 cases (92 %), surgery was performed on a single lumbar motor segment. In 15 cases (8 %), indications for surgery at two levels were determined. In 45 cases (24.1 %), ongoing degeneration of the segment was identified. Of these, 32 (17.2 %) required repeated hospitalization in a hospital with a diagnosis of “Disc herniation relapse”. The results in the form of complete regression or a significant reduction in pain syndrome in the postoperative period were assessed as positive in 85 % of cases. The persistence of varying degrees of pain syndrome at this level and a subjective negative assessment were identified in 28 patients – in 15 %. Repeated revision intervention was performed in 29 (15. 5 %) cases. Of the 186 patients who underwent surgery, 120 (64.5 %) underwent rehabilitation measures at the medical rehabilitation department of the TINAKI Center for Rehabilitation and Social Services in Astrakhan. Conclusion. Active surgery for degenerative spinal diseases aimed at decompression of neural structures does not guarantee a positive result in terms of pain relief. Timely and important course of full-fledged rehabilitation contributes to the reduction of pain syndrome and improvement of the quality of life of patients.

1. Aihara T., Takahashi K., Ogasawara A. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study. J Bone Joint Surg Br. 2005; 87 (5): 687–691.

2. Lønne G., Solberg T. K., Sjaavik K., Nygaard Ø. P. Recovery of muscle strength after microdiscectomy for lumbar disc herniation: a prospective cohort study with 1-year follow-up. Eur Spine Journal. 2012; 21 (4): 655–659.

3. Simonovich A. E., Baikalov A. A. Surgical treatment of relapses of pain syndromes after removal of hernia of lumbar intervertebral discs. Khirurgiya pozvonochnika = Spine Surgery. 2005; 3: 87–92 (In Russ.).

4. Swartz K. R., Trost G. R. Recurrent lumbar disc herniation. Neurosurg. Focus. 2003; 15 (3): Е10.

5. Hasegawa K., Kitahara K., Hara T., Takano K., Shimoda H., Homma T. Evaluation of lumbar segmental instability in degenerative diseases by using a new intraoperative measurement system. J Neurosurg Spine. 2008; 8 (3): 255–262. doi: 10.3171/spi/2008/8/3/255.

6. Fritzell P., Knutsson B., Sanden B., Stromqvist B., Hagg O. Recurrent versus primary lumbar disc herniation surgery: patient-reported outcomes in the Swedish Spine Register Swespine. Clin Orthop Relat Res. 2015; 473: 1978–1984. doi: 10.1007/s11999-014-3596-8.

7. Diagnosis and treatment of degenerative lumbar spinal stenosis. NASS Evidence-Based Clinical Guidelines Committee. North American Spin Society. Evidence-based clinical guidelines for multidisciplinary spine care. 2011.

8. Mannion A., Denzler R., Dvorak J., Müntener M., Grob D. A randomized controlled trial of postoperative rehabilitation surgical decompression of the lumbar spine. URL: https://pubmed.ncbi.nlm.nih.gov/17593405/.

9. McGregor A. H., Dore C. J., Morris T. P., Morris S. ISSLS prize winner: function after spinal treatment, exercise, and rehabilitation (FASTER): a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved. Spine. 2011; 36 (21): 1711–1720.

10. Oosterhuis T., Costa L. O., Maher C. G., de Vet H. C. Rehabilitation after lumbar disc surgery. Cochrane Database Syst. Rev. 2014; 14 (3).

11. Borodulina I. V., Badalov N. G., Mukhina A. A., Gushcha A. O. Hydrogalvanic Baths as a Method of Medical Rehabilitation: A Review of the Literature and Prospects for Clinical Application. Issues of balneology, physiotherapy and medical physical education = Issues of Balneology, Physiotherapy, and Therapeutic Physical Culture. 2018; 95: 46–52 (In Russ.).

12. Rushton A., Wright C., Goodwin P. Physiotherapy Rehabilitation Post First Lumbar Discectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The Spine Journal. 2011; 36 (14): 961–972.

13. Attala N., Ayache S. S., Ciampi De Andrade D., Mhalla A. Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy: a randomized sham-controlled comparative study. Pain. 2016; 157 (6): 1224–1231.

14. Kumru H., Albu S., Vidal J., Tormos J. M. Effectiveness of repetitve transcranial magnetic stimulation in neuropathic pain. Disabil. Rehabil. 2016; 39: 1–11.

15. Kolesnichenko V. A. Modern Trends in Physical Rehabilitation of Patients with Lumbar Osteochondrosis after Surgical Intervention. Pedagogika. Psikhologiya = Pedagogy. Psychology. 2012; 12: 53–56.

16. Gushcha A. O., Yusupova A. R. Experience in minimally invasive surgery and a modern view on the treatment of degenerative spinal lesions. Voprosy neyrokhirurgii imeni N. N. Burdenko = N. N. Burdenko Neurosurgery Issues. 2021; 85 (1): 5–9. doi: 10.17116/neiro2021850115.