Postoperative Recommendations for Single level Lumbar disc Herniation: A cross-section survey

Abstract

Background and Aim: Lumbar degenerative disc disease is one of the leading causes of low back and leg pain. Conservative treatment is the mainstay treatment. For some patients it is not enough, and surgical approach is needed. The literature concerning recommendations on patients' return to work and restart of daily-living activities after surgery is sparse. Therefore, the aim of this study is to assess surgeons' consensus concerning the time periods until return to work and restart of housework and daily living activities. Methods: An online GoogleForms based survey was sent, via electronic mail, during January 2022, to 243 surgeons described as having expertise in spine surgery, using the dissemination means of Sociedade Portuguesa de Patologia da Coluna Vertebral and Sociedade Portuguesa de Neurocirurgia. Participants (n=59) had predominantly hybrid clinical practice in Neurosurgery field. Results: Nearly 68 % of participants advised patients to return to sedentary professional work up until the 4th postoperative week. Light and heavy workload workers were advised to wait longer until initiating work activity. Only in a minority of cases (1.7%) no recommendation was given to patients. Low mechanical impact activities are predominantly started up to 4 weeks, and higher stress activities should be further postponed (4-12 weeks after surgery). Half of the surveyed surgeons estimates to refer to rehabilitation 10% or more patients. Neurological and physiological parameters support the indication for rehabilitation. No differences were found when comparing recommendations given by more and less experienced surgeons - as defined by the number of years in practice and the burden of annual surgeries- for most activities. The same is true for the comparison between orthopedic surgeons and neurosurgeons. No significant differences were identified for annual surgical volume (p=0.466), number of years in practice (p=0.105), specialty (p=0.833) or practice type (p=0.397) in terms of percentage of patients referred to rehabilitation. Conclusion: Despite not having clear guidelines in postoperative management of surgically treated patients, Portuguese clinical practice is in line with international experience and literature.