The number of operations for herniated lower back discs has fallen dramatically in the past couple of years since clinical trials showed that patients were no better off 2 years after surgery compared with conservative management (typically manual therapy and good advice!). However, there are instances where surgery (usually microdiscectomy) is unavoidable, notably in cases of cauda equina syndrome (which usually involves some disturbance to bladder, bowel or sexual function, or a combination of these). In such cases the patient needs to recover as much function as possible and control their pain. The question is how best to rehabilitate patients after they’ve had disc surgery. Having seen many patients with scar tissue in their lower backs following previous surgery I was interested to read a study recently which compared the effectiveness of osteopathy with an exercise-only programme immediately after surgery. The results support the use of osteopathy in the rehabilitation process. Here is a summary of the report:
- • 33 people were randomly assigned to one of 2 groups: Group A received osteopathy treatment, Group B consisted of the exercise-only group. The osteopathy treatment was aimed at allelviating stiffness/tension, reducing biomechanical loading on the lumbar spine, and by improving overall spinal mechanics
• Patients received the allocated intervention twice a week for 4 weeks. Each session was 30 minutes
• Primary outcomes were post-surgical functional disability and intensity of low back and leg pain
• Outcome measures were assessed at baseline (2-3 weeks after surgery) and post-intervention (7-8 weeks after surgery)
• Results: both interventions improved all primary and secondary outcomes. Post-surgical physical disability improved more with OMT rehabilitation than the exercise programme (54% vs. 26%, P < 0.05). Residual leg pain decreased with OMT (53%) and exercise (17%). Post-operative low back pain decreased by 37% in the OMT group and 10% in the exercise group. Patients in both groups required less frequent use of medication and were highly satisfied with the rehabilitation interventions. No side effects or complications from any intervention were reported
This is a very encouraging study which supports the use of osteopathy post microdisdcectomy.
BYUNGHHO J. Kim, et al. 2015. Rehabilitation with osteopathic manipulative treatment after lumbar disc surgery: A randomised, controlled pilot study. International Journal of Osteopathic Medicine, 18 (3) pp.181-188.