The effect of short (2-weeks) versus long (6-weeks) post-operative restrictions following lumbar discectomy: a prospective randomized control trial.
We sought to evaluate how short (2-week) versus long (6-week) post-operative restrictions following lumbar discectomy impacted outcomes and reherniation rates for a period up to 1 year following surgery.



This study included 108 patients undergoing index lumbar discectomy. Patients were randomized immediately following surgery. Outcomes included back and leg visual analog pain scales (VAS), Oswestry Disability Index (ODI), and reherniation rates at 2-weeks, 6-weeks, 3-months, and 1-year following surgery. Differences in reherniation rates were analyzed using Fisher's exact test. VAS and ODI scores were evaluated using Student's t test.



Six patients (11%) in the 2-week restriction group had a reherniation event and four patients (7%) in the 6-week restriction group experienced a reherniation (p = 0.52). VAS back pain (p < 0.001), leg pain (p < 0.001), and ODI scores (p < 0.001) were significantly improved for both cohorts as compared to baseline at the 2-week time point and remained significantly improved through 1-year [VAS back (p < 0.001); VAS leg (p < 0.001); ODI (p < 0.001)]. No significant differences in ODI, VAS back, or VAS leg scores were detected at any of the time points between the 2- and 6-week restriction groups.



The results of this randomized trial suggest equivalent clinical outcomes irrespective of the length of post-operative restriction. From a clinical perspective, if patients are deemed at low risk for a reherniation event they may be confidence that early return to activity at 2 weeks will not compromise outcomes and may not adversely impact the risk of reherniation. Level of Evidence II.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. bonocm@me.com.
Christopher M
CM
Bono
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Dana A
DA
Leonard
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Thomas D
TD
Cha
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Joseph H
JH
Schwab
Department of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94304, USA.
Kirkham B
KB
Wood
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Mitchel B
MB
Harris
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Andrew J
AJ
Schoenfeld
D000328:Adult; D001416:Back Pain / Q000209:etiology; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery*; D062707:Return to Work
Lumbar discetomy; Post-operative restriction; Randomized trial; Rehabilitation; Reherniation