Nie Cong, Chen Kaiwen, Huang Mei, Zhu Yu, Jiang Jianyuan, Xia Xinlei, Zheng Chaojun
Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid- Wulumuqi Road, Shanghai, 200040, China.
Department of Nursing, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Eur Spine J. 2025 Jan;34(1):191-203. doi: 10.1007/s00586-024-08541-x. Epub 2024 Oct 25.
This prospective randomized controlled trial aimed to investigate the impact of early postoperative sequential motor control (starting first day post-operatively) and core stabilization training (starting fifth week post-operatively) compared to conventional exercise (starting fifth weeks post-operatively) on the risk of developing persistent spinal pain syndrome type-2 (PSPS-T2).
395 patients with lumbar degenerative diseases (LDDs) undergoing modified transforaminal lumbar interbody fusion and a 12-week postoperative exercise program (sequential vs. conventional exercise: 214 vs. 181) were evaluated for low back pain (LBP) intensity, Oswestry Disability Index (ODI), pressure pain threshold (PPT), temporal summation (TS), fatty infiltration of paraspinal muscles, transversus abdominis (TrA) activation capacity and Fear-Avoidance Beliefs Questionnaire (FABQ) pre-operatively, 3 months post-operatively, and 1 year post-operatively.
At 3-month postoperative assessment, LBP in sequential exercise group were lower than those in conventional exercise group (P < 0.05), and sequential-exercise patients had greater local-area PPTs, lower TS, lower TrA activation capacities and less fatty infiltration of erector spinae than did the conventional-exercise patients (P < 0.05). At 1-year postoperative assessment, fewer sequential-exercise patients had PSPS-T2 compared with conventional-exercise patients (11/214 vs. 20/181; P < 0.05). LBP at rest and FABQ were lower in sequential-exercise patients than conventional-exercise patients (P < 0.05). Furthermore, both PPT and TS at 1-year postoperative assessment were associated with these measurements at 3-month postoperative assessment in patients with PSPS-T2 (P < 0.05).
Postoperative sequential exercise has more positive effects to avoid PSPS-T2 than conventional exercise in patients with LDDs possibly because of its advantages in improving central and peripheral sensitization.
本前瞻性随机对照试验旨在研究术后早期序贯运动控制（术后第一天开始）和核心稳定训练（术后第五周开始）与传统运动（术后第五周开始）相比，对发生2型持续性脊柱疼痛综合征（PSPS-T2）风险的影响。
对395例接受改良经椎间孔腰椎椎间融合术及12周术后运动计划的腰椎退行性疾病（LDDs）患者（序贯运动与传统运动：214例 vs. 181例），在术前、术后3个月和术后1年评估其腰痛（LBP）强度、Oswestry功能障碍指数（ODI）、压痛阈值（PPT）、时间总和（TS）、椎旁肌脂肪浸润、腹横肌（TrA）激活能力和恐惧回避信念问卷（FABQ）。
术后3个月评估时，序贯运动组的LBP低于传统运动组（P < 0.05），序贯运动患者比传统运动患者具有更高的局部PPT、更低的TS、更低的TrA激活能力和更少的竖脊肌脂肪浸润（P < 0.05）。术后1年评估时，与传统运动患者相比，序贯运动患者发生PSPS-T2的较少（11/214 vs. 20/181；P < 0.05）。序贯运动患者静息时的LBP和FABQ低于传统运动患者（P < 0.05）。此外，在PSPS-T2患者中，术后1年评估时的PPT和TS与术后3个月评估时的这些测量值相关（P < 0.05）。
在LDDs患者中，术后序贯运动在避免PSPS-T2方面比传统运动具有更积极的效果，可能是因为其在改善中枢和外周敏化方面具有优势。
