Introduction: Lumbar Fusion is an increasingly common treatment offered to patients with degenerative instability of the spine who have failed non-operative modalities. Often, a course of rehabilitation is recommended post-operatively. There remain, however, a number of questions as to the clinical benefits, appropriate timing, and the proper modalities to be included in such rehabilitation.
Methods: We used the PRISMA guidelines to conduct an exhaustive review of multiple electronic databases up until December, 2014 . When appropriate, additional studies were identified from the bibliographies of cited studies and after discussions with study authors. Data extraction and synthesis was performed by a multidisciplinary team of care providers involved the management of post-fusion patients.
Results: Our initial search resulted in 1875 articles. From these, 450 full-text articles were independently reviewed by at least two authors. After further detailed analysis, a total of 165 full-text articles were included in the systematic review. In general, the literature supports use of physical rehabilitation modalities after lumbar fusion surgery. Institution of physical therapy at the 12 week post-operative mark results in better outcomes at lower cost than earlier, 6 week institution. Where available, psychosocial support is very helpful to these patients. A wide list of unanswered questions remain, including the some differences in semantics among caregivers and other stake-holders. The data supporting an optimal protocol for post-fusion rehabilitation remains elusive, but, using the data available, we have crafted a model protocol which is undergoing prospective study at present.
Conclusions: Rehabilitation has long been a common feature in the post-operative management of spinal fusion patients. While most care-givers agree that most patients will benefit from this effort, the supporting data remains sparse. At this point, we can offer some general comments about timing and useful modalities, but much additional research is required.
Patient Care: 1) Create patient driven rehabilitation protocol.
2) Provide better understanding of cost per quality adjusted life year features and its impact on patient reported function and satisfaction.
Learning Objectives: To provide a systematic and comprehensive review of the existing literature regarding post-fusion rehabilitation in order to guide the treatment team in the optimal utilization of these modalities.