Rehabilitation Following Lumbar Disc Surgery

Study Overview
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Brief Summary
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The proposed study will be a randomized clinical trial designed to determine the most effective physical therapy program for individuals who have undergone lumbar discectomy surgery. The study will compare two different post-operative physical therapy programs (general strengthening or general + specific strengthening). Both groups will begin treatment 2 weeks post-surgery. Subjects in both groups will receive weekly treatment sessions for 8 weeks with a treatment program emphasizing exercises shown to activate the large trunk muscles without imposing potentially harmful compression or shear forces. The general + specific strengthening group will also receive exercises shown to isolate activation of the deep trunk muscles, in particular the multifidus, with training augmented by the use of diagnostic ultrasound biofeedback. Patient assessments will be conducted pre- and post-surgery, as well as 10 (post-treatment) and 26 weeks after surgery.

Official Title
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Examining the Effectiveness of a Post-operative Rehabilitation Program Emphasizing Restoration of Multifidus Muscle Function for Individuals Undergoing Lumbar Discectomy: a Randomized Clinical Trial

Conditions
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Lumbar Disc Herniation, Radiculopathy

Intervention / Treatment
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* Other: Rehabilitation following lumbar disc surgery (discectomy)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-60 years old Diagnosis of LDH based on imaging (MRI or CT scan) of the lumbar spine with concurring clinical examination findings (based on the judgment of the attending neurosurgeon) Appropriate surgical candidate based on the opinion of the attending spine surgeon, and scheduled for single-level lumbar discectomy (open or micro-discectomy). Able to attend weekly treatment sessions. Exclusion Criteria: Prior surgery to the lumbar spine Spondylolytic or degenerative spondylolisthesis present on pre-surgical imaging Unable to speak and understand English Peri- or post-operative complication (infection, nerve injury, dural tear, vascular injury, etc.) that would limit or delay the ability to participate in post-operative rehabilitation. Multi-level surgery or the use of instrumentation during surgery (i.e., lumbar fusion)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br>General exercise. Participants in this group will perform aerobic exercise, range of motion exercise and general strengthening exercise. | Other: Rehabilitation following lumbar disc surgery (discectomy)<br>* Exercise: walking, range of motion, and general trunk strengthening with or without specific trunk muscle motor control exercises.<br>|
| Experimental: 2<br>Specific exercise. Participants in this group will perform aerobic exercise, range of motion exercise, and specific motor control exercises. | Other: Rehabilitation following lumbar disc surgery (discectomy)<br>* Exercise: walking, range of motion, and general trunk strengthening with or without specific trunk muscle motor control exercises.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Oswestry disability index |  | Preoperative, 2 postoperative weeks, 10 postoperative weeks, 6 postoperative months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lumbar multifidus muscle activation as estimated by diagnostic ultrasound imaging |  | preoperative, 2 postoperative weeks, 10 postoperative weeks, 6 postoperative months |