Lee Chong-Suh, Kang Kyung-Chung, Chung Sung-Soo, Park Won-Hah, Shin Won-Ju, Seo Yong-Gon
Departments of 1 Orthopedic Surgery and.
Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea.
J Neurosurg Spine. 2017 Feb;26(2):163-170. doi: 10.3171/2016.7.SPINE151132. Epub 2016 Oct 14.
OBJECTIVE There is a lack of evidence of how back muscle strength changes after lumbar fusion surgery and how exercise influences these changes. The aim of this study was to evaluate changes in back muscle strength after posterior lumbar interbody fusion (PLIF) and to measure the effects of a postoperative exercise program on muscle strength and physical and mental health outcomes. METHODS This prospective study enrolled 59 women (mean age 58 years) who underwent PLIF at 1 or 2 spinal levels. To assess the effects of a supervised lumbar stabilization exercise (LSE), the authors allocated the patients to an LSE (n = 26) or a control (n = 33) group. The patients in the LSE group performed the LSEs between 3 and 6 months postoperatively. Back extensor strength, visual analog scale (VAS) scores in back pain, and physical component summary (PCS) and mental component summary (MCS) scores on the 36-Item Short Form Health Survey were determined for the both groups. RESULTS Mean strength of the back muscles tended to slightly decrease by 7.5% from preoperatively to 3 months after PLIF (p = 0.145), but it significantly increased thereafter and was sustained until the last follow-up (38.1%, p < 0.001). The mean back muscle strength was similar in the LSE and control groups preoperatively, but it increased significantly more in the LSE group (64.2%) than in the control group (21.7%) at the last follow-up 12 months after PLIF (p = 0.012). At the last follow-up, decreases in back pain VAS scores were more significant among LSE group patients, who had a pain reduction on average of 58.2%, than among control group patients (reduction of 26.1%) (p = 0.013). The patients in the LSE group also had greater improvement in both PCS (39.9% improvement) and MCS (20.7% improvement) scores than the patients in the control group (improvement of 18.0% and 1.1%, p = 0.042 and p = 0.035, respectively). CONCLUSIONS After PLIF, strength in back muscles decreased until 3 months postoperatively but significantly increased after that period. The patients who regularly underwent postoperative LSE had significantly improved back strength, less pain, and less functional disability at 12 months postoperatively.
目的 缺乏关于腰椎融合手术后背部肌肉力量如何变化以及运动如何影响这些变化的证据。本研究的目的是评估后路腰椎椎间融合术（PLIF）后背部肌肉力量的变化，并测量术后运动计划对肌肉力量以及身心健康结果的影响。方法 这项前瞻性研究纳入了59名在1或2个脊柱节段接受PLIF的女性（平均年龄58岁）。为了评估有监督的腰椎稳定运动（LSE）的效果，作者将患者分为LSE组（n = 26）或对照组（n = 33）。LSE组患者在术后3至6个月进行LSE。测定两组患者的背部伸肌力量、背痛视觉模拟量表（VAS）评分以及36项简短健康调查问卷的身体成分总结（PCS）和心理成分总结（MCS）评分。结果 从术前到PLIF后3个月，背部肌肉的平均力量倾向于轻微下降7.5%（p = 0.145），但此后显著增加并持续到最后一次随访（增加38.1%，p < 0.001）。术前LSE组和对照组的背部肌肉平均力量相似，但在PLIF后12个月的最后一次随访时，LSE组的增加幅度（64.2%）明显大于对照组（21.7%）（p = 0.012）。在最后一次随访时，LSE组患者的背痛VAS评分下降更为显著，平均疼痛减轻58.2%，而对照组患者为26.1%（p = 0.013）。LSE组患者的PCS评分（改善39.9%）和MCS评分（改善20.7%）也比对照组患者有更大改善（分别改善18.0%和1.1%，p = 0.042和p = 0.035）。结论 PLIF后，背部肌肉力量在术后3个月内下降，但此后显著增加。定期进行术后LSE的患者在术后12个月时背部力量显著改善，疼痛减轻，功能障碍减少。
