Brotis Alexandros G, Kalogeras Adamantios, Spiliotopoulos Theodosios, Fountas Kostas N, Demetriades Andreas K
Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, UK.
Brain Spine. 2025 Mar 13;5:104238. doi: 10.1016/j.bas.2025.104238. eCollection 2025.
The role of physical therapy after lumbar disc herniation surgery is unclear.
To determine the impact of physical therapy following LDH surgery (Q1), investigate the effects of activity limitations (Q2), the best time to start physical therapy (Q3), the significance of supervised physical rehabilitation (Q4), the types of physical therapies used (Q5), and the role of additional approaches, such as education, manipulation, and acupuncture, in enhancing the effectiveness of rehabilitation (Q6).
This systematic review searched three databases from inception to May 2024. Independent reviewers screened studies, assessed and extracted data, and critically appraised the quality of the available evidence.
This systematic review included 55 randomized controlled trials with 4311 patients. We demonstrated that physical therapy after lumbar disc surgery is effective in alleviating pain and improving function and quality of life after surgery for lumbar disc herniation. Exercise regimens aimed at enhancing the endurance, flexibility, and strength of the back musculature are generally efficacious, with the exception of exercises involving neural mobilization. Imposing limitations on physical activity does not yield substantial advantages; however, the occurrence rate of potential complications, the optimal timing for initiating activity and the cost-effectiveness of supervised exercise remain subjects of ongoing discourse. Concurrent application of manual therapy, acupuncture, educational interventions, and behavioral and occupational therapy has the potential to augment outcomes.
Physical therapy improves functional outcomes after lumbar disc surgery. Further studies should address its safety, and cost-effectiveness, and provide dissemination and applicability tools.
腰椎间盘突出症手术后物理治疗的作用尚不清楚。
确定腰椎间盘突出症手术（LDH）后物理治疗的影响（问题1），调查活动受限的影响（问题2），开始物理治疗的最佳时间（问题3），监督物理康复的意义（问题4），所使用的物理治疗类型（问题5），以及教育、手法治疗和针灸等其他方法在提高康复效果方面的作用（问题6）。
本系统评价检索了从创刊到2024年5月的三个数据库。独立评审员筛选研究、评估和提取数据，并严格评估现有证据的质量。
本系统评价纳入了55项随机对照试验，共4311例患者。我们证明，腰椎间盘手术后的物理治疗在减轻疼痛以及改善腰椎间盘突出症手术后的功能和生活质量方面是有效的。旨在增强背部肌肉耐力、柔韧性和力量的运动方案通常是有效的，但涉及神经松动的运动除外。对身体活动加以限制并没有带来实质性的好处；然而，潜在并发症的发生率、开始活动的最佳时机以及监督运动的成本效益仍是正在讨论的话题。同时应用手法治疗、针灸、教育干预以及行为和职业治疗有可能提高治疗效果。
物理治疗可改善腰椎间盘手术后的功能结局。进一步的研究应关注其安全性、成本效益，并提供传播和应用工具。
