Postoperative rehabilitation following lumbar discectomy with quantification of trunk muscle morphology and function: a case report and review of the literature

J Orthop Sports Phys Ther. 2010 Jul;40(7):402-12. doi: 10.2519/jospt.2010.3332.

Abstract

Study design: A case report and literature review.

Background: Optimizing clinical outcomes following lumbar disc surgery is a research priority; however, relatively little attention has been paid to the postoperative management of this population. The transversus abdominis and lumbar multifidus (LM) muscles appear to play a unique role in lumbar spine stability, and may relate to clinical outcome following lumbar disc surgery. The purpose of this case report was to describe the preoperative LM morphology, clinical outcome, and change in transversus abdominis and LM muscle activation in a patient following lumbar disc surgery and motor control exercise initiated in the early postoperative period.

Case description: A 29-year-old female underwent an 8-week postoperative rehabilitation program emphasizing motor control exercises to restore trunk muscle function 10 days following lumbar disc surgery.

Outcomes: The patient experienced clinically important improvements in pain and disability following the postoperative rehabilitation program. Substantial improvements in muscle activation were observed of the transversus abdominis and the LM at the L4-5 level. Minimal change in LM activation and a higher proportion of intramuscular fat was observed at the L5-S1 level.

Discussion: This case report represents limited evidence regarding the feasibility of instituting a rehabilitation program in the early postoperative period following lumbar disc surgery. Improvements in clinical status and muscle function were observed, and a differential change in muscle activation between the L4-5 and L5-S1 levels was noted. The literature regarding rehabilitation following lumbar disc surgery, as well as the neuromuscular changes observed in this population, was reviewed. Additionally, a novel method of examining LM morphology was described and suggestions were made for directions of future research.

Level of evidence: Therapy, level 4.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Muscles / anatomy & histology*
  • Abdominal Muscles / physiology
  • Adult
  • Body Fat Distribution*
  • Diskectomy / rehabilitation*
  • Exercise Therapy*
  • Female
  • Humans
  • Isometric Contraction
  • Lumbar Vertebrae / surgery*
  • Magnetic Resonance Imaging