Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery?

Arch Phys Med Rehabil. 2020 Aug;101(8):1389-1395. doi: 10.1016/j.apmr.2020.04.006. Epub 2020 May 13.


Objective: To quantify and compare utilization of opioids, exercise therapy, and physical therapy in the year before spine surgery.

Design: A retrospective cohort of surgical and claims data.

Setting: Beneficiaries of the Military Health System seen at Brooke Army Medical Center PARTICIPANTS: Patients (N=411) undergoing surgery between January 1, 2014, and December 31, 2015, identified retrospectively through the Surgical Scheduling System (S3) based on procedure type (fusion, laminectomy, arthroplasty, vertebroplasty, and diskectomy).

Interventions: Elective lumbar spine surgery.

Main outcome measures: Health care utilization variables present during the full 12 months before surgery, which included physical therapy services and visits for exercise therapy or manual therapy procedures and opioid prescriptions.

Results: The mean age of participants was 44.8±11.7 years and 32.4% were female. In the year before surgery, 143 (34.8%) patients had a physical therapy plan of care, 140 (34.1%) had at least 1 visit that included exercise therapy, and only 60 (14.6%) had a minimum of 6 exercise therapy visits. However, 347 (84.4%) patients received at least 1 opioid prescription fill (mean of 6.1 unique fills).

Conclusions: Before elective lumbar spine surgery, opioid prescriptions were common but physical therapy services and exercise therapy utilization occurred infrequently.

Keywords: Chronic pain; Neurosurgery; Opioids; Pack pain; Rehabilitation.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use*
  • Conservative Treatment / methods
  • Conservative Treatment / statistics & numerical data
  • Diskectomy
  • Elective Surgical Procedures / statistics & numerical data
  • Exercise Therapy / statistics & numerical data*
  • Female
  • Humans
  • Laminectomy
  • Low Back Pain / therapy*
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Physical Therapy Modalities / statistics & numerical data
  • Preoperative Period
  • Retrospective Studies
  • Spinal Fusion
  • Vertebroplasty
  • Young Adult


  • Analgesics, Opioid