A prolapsed lumbar disc (also called a 'slipped' or 'herniated' disc) is thought to be the most common cause of sciatica (pain or numbness spreading over the buttocks or legs caused by a 'pinched' or compressed nerve in the lower back). Many patients are treated effectively by a combination of non-surgical measures such as medication or physiotherapy. However, patients with persistent symptoms often have surgery. While 60% to 90% of patients will improve after surgery, some will continue to have symptoms. It is estimated that 3% to 12% of patients who have disc surgery will develop another prolapsed disc and most of these patients will have surgery again.
Active treatment programs, such as physiotherapy, in which the patient is an active participant, and advice to return to normal activities, including work, as soon as possible after surgery are common approaches.
This updated review evaluated the effectiveness of various active treatment programs for patients who had lumbar disc surgery for the first time. The review authors included 14 randomised controlled trials with 1927 participants between the ages of 18 and 65 years. Most commonly, treatment started four to six weeks after surgery, but this ranged from two days to 12 months. There was also considerable variation in the content, duration and intensity of the treatments. Most of the treatments were only assessed in one trial and their results are presented in the full review.
For programs that started four to six to six weeks after surgery, the review authors were able to pool the results for three comparisons:
- Patients who participated in exercise programs reported a slightly less short-term pain and disability than those who received no treatment.
- Patients who participated in high intensity programs reported slightly less short-term pain and disability than those in low intensity programs.
- Those in supervised exercise programs reported little or no difference in pain and disability than those in home exercise programs.
None of the included studies reported that active programs increased the rate of repeated surgery, nor did the evidence suggest that patients should restrict their activities after lumbar disc surgery. However, limitations in the methods of half of the trials suggest the results should be read with caution.
The evidence does not tell us whether all patients should be treated after surgery or only those who still have symptoms four to six weeks later.