Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To determine the feasibility of removing activity restrictions after surgery and encouraging early return to work; to ascertain the clinical and behavioral response to such a strategy; and to identify factors predictive of early return to work, preparatory to possible randomized clinical trials. SUMMARY OF BACKGROUND INFORMATION: Current practice usually entails several weeks to several months of restricted activities after lumbar discectomy to avoid disc "reinjury." Earlier work has suggested these restrictions may not be necessary. METHODS: One hundred fifty-two consecutive working patients undergoing limited open discectomy for herniated lumbar intervertebral disc were treated postoperatively with no activity restrictions. Patients were encouraged to return to full activities as soon as possible. The patients were followed for a minimum of 2 years (average follow-up time = 4.8 years). At follow-up, an independent examiner evaluated each patient and collected further postoperative data. RESULTS: One hundred forty-nine of the 152 patients (98%) returned to work. The average work loss was 1.2 weeks and 148 of 149 patients had returned to full duty by 8 weeks. Approximately one-third of the group returned to work within 1 week of surgery (32%), many the next day. Statistical analysis demonstrated very early return to work did not correlate with either recurrent sciatica, reoperation for reherniation, or ultimate clinical outcome. Seventeen patients (11.2%) had possible reherniations (recurrent sciatica) and eight underwent reoperation (5.3%). CONCLUSION: Lifting of postoperative activity restrictions after limited discectomy allowed shortened time to return to work relative to the 4 to 16 weeks commonly recommended. Complication rates appear comparable to those reported in the literature for patients under postoperative restrictions. Postoperative restrictions may not be necessary in most patients.     

Is lumbar discography a determinate of discogenic low back pain: provocative discography reconsidered

Provocative lumbar discography was investigated in a series of clinical studies at the Stanford University of Medicine, Stanford, CA. This work demonstrated that pain intensity during disc injection is strongly influenced by the subject's emotional and psychological profiles, chronic pain behavior, and ongoing compensation claims whether the patient has any back pain illness or not. Pain reproduction was also primarily related to penetration of the dye through the outer annulus and could not reliably be used to confirm the location of the pain source.     

Course and Prognostic Factors for Neck Pain in the General Population

European Spine Journal - Best evidence synthesis. To undertake a best evidence synthesis on course and prognosis of neck pain and its associated disorders in the general population. Knowing the...     

The Burden and Determinants of Neck Pain in Workers

European Spine Journal - Systematic review and best evidence synthesis. To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in...     

Research Priorities and Methodological Implications

European Spine Journal - Best evidence synthesis. To report on gaps in the literature and make methodologic recommendations based on our review of the literature on frequency and risk factors,...