Haddas Ram, Remis Andréas, Barzilay Yair, Puvanesarajah Varun, Keller Jake, Clifford Brian M, Lantz Justin M, Mayer John M
Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, United States.
Department of Physical Therapy, Duke University, Durham, NC, United States.
N Am Spine Soc J. 2025 May 30;23:100620. doi: 10.1016/j.xnsj.2025.100620. eCollection 2025 Sep.
Therapeutic exercise is often part of the rehabilitation process following lumbar spine surgery. Despite this utilization, high-quality evidence and specific guidance regarding therapeutic exercise parameters and protocols following lumbar spine surgery remain sparse. The purpose of this manuscript is to provide a narrative review of the current evidence regarding exercise prescription, activity recommendations, and outcome measures following lumbar discectomy, fusion, and total disc replacement surgeries.
A comprehensive narrative review was conducted regarding postoperative exercise for lumbar spine surgery, a summary of the current available literature was provided and interpreted, and future directions for research were identified.
The findings of narrative review generally support supervised therapeutic exercise as safe and beneficial following lumbar discectomy, fusion, and total disc arthroplasty surgeries. Initial exercise prescriptions should be individualized according to patient and surgical factors, including prior level of function, comorbidities, and tissue healing timelines, to support recovery goals. These findings can be useful for surgeons and rehabilitation practitioners to provide general guidance and to counsel patients on appropriate therapeutic exercises and activity recommendations following lumbar spine surgery, with a particular focus on the safety of exercise types and when to initiate exercise postoperatively. Physical activity monitoring (eg, wearables) can be used to complement postsurgical therapeutic exercise and enhance outcomes.
This review provides the most current evidence regarding the safety and effectiveness of therapeutic exercise following lumbar spine surgery. Given the narrative format of this review, these findings are not intended to serve as clinical practice guidelines or provide specific recommendations about implementation. Thus, pragmatic implementation of exercise following lumbar spine surgery depends on the patient's distinct presentation, surgical factors, expertise and experience of the clinician, available resources, and patient preferences. Future prospective research trials and subsequent systematic reviews are needed to elucidate specific factors regarding the use of therapeutic exercise following lumbar spine surgery.
治疗性运动通常是腰椎手术后康复过程的一部分。尽管有这种应用，但关于腰椎手术后治疗性运动参数和方案的高质量证据及具体指导仍然匮乏。本文的目的是对腰椎间盘切除术、融合术和全椎间盘置换术后运动处方、活动建议及结局指标的现有证据进行叙述性综述。
对腰椎手术术后运动进行了全面的叙述性综述，提供并解读了现有文献的总结，并确定了未来的研究方向。
叙述性综述的结果总体上支持在腰椎间盘切除术、融合术和全椎间盘置换术后进行有监督的治疗性运动是安全且有益的。初始运动处方应根据患者和手术因素进行个体化制定，包括既往功能水平、合并症和组织愈合时间线，以支持康复目标。这些发现有助于外科医生和康复从业者提供一般指导，并就腰椎手术后适当的治疗性运动和活动建议为患者提供咨询，尤其关注运动类型的安全性以及术后何时开始运动。身体活动监测（如可穿戴设备）可用于补充术后治疗性运动并改善结局。
本综述提供了关于腰椎手术后治疗性运动安全性和有效性的最新证据。鉴于本综述的叙述形式，这些发现并非旨在作为临床实践指南或提供关于实施的具体建议。因此，腰椎手术后运动的实际实施取决于患者的独特表现、手术因素、临床医生的专业知识和经验、可用资源以及患者偏好。未来需要进行前瞻性研究试验及后续的系统评价，以阐明腰椎手术后治疗性运动使用的具体因素。
