# Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review

## TL;DR

This review finds limited evidence on effective post-surgery rehabilitation for lumbar disc herniation, with some short-term benefits from Pilates and magnetic therapy.

## Contribution

The study identifies two short-term beneficial interventions and highlights the lack of high-quality evidence in post-surgical rehabilitation for lumbar disc herniation.

## Key findings

- Pilates exercise may improve function shortly after surgery.
- Whole-body magnetic therapy may reduce low back pain intensity.
- Pregabalin showed no benefit and may be harmful for post-surgical pain.

## Abstract

The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear.

To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH.

This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach.

This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events.

Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

•The evidence on the rehabilitation of post-surgical lumbar disc herniation is sparse•Pilates exercise may improve function in the short term•Whole-body magnetic therapy may be associated with reducing post-surgical back pain•Pregabalin may be iatrogenic as a post-surgical intervention for low back pain•High-quality trials are urgently needed to inform post-surgical rehabilitation

The evidence on the rehabilitation of post-surgical lumbar disc herniation is sparse

Pilates exercise may improve function in the short term

Whole-body magnetic therapy may be associated with reducing post-surgical back pain

Pregabalin may be iatrogenic as a post-surgical intervention for low back pain

High-quality trials are urgently needed to inform post-surgical rehabilitation