Turkish Neurosurgery 2017 , Vol 27 , Num 3
A Rehabilitation Protocol for Patients with Lumbar Degenerative Disc Disease Treated with Posterior Transpedicular Dynamic Stabilization
Nazan CANBULAT1,Tunc OKTENOGLU2,Yaprak ATAKER3,Mehdi SASANI2,Omur ERCELEN4, Onder CEREZCI3,Tuncer SUZER5,Ali Fahir OZER5
1Koc University, School of Medicine, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
2American Hospital, Neurosurgery Department, Istanbul, Turkey
3American Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
4Koc University, School of Medicine, Anesthesiology and Pain Management Department, Istanbul, Turkey
5Koc University, School of Medicine, Neurosurgery Department, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.16326-15.1 AIM: To evaluate the efficacy of the rehabilitation protocol on patients with lumbar degenerative disc disease after posterior transpedicular dynamic stabilization (PTDS) surgery.

MATERIAL and METHODS: Patients (n=50) with single level lumbar degenerative disc disease were recruited for this study. Patients had PTDS surgery with hinged screws. A rehabilitation program was applied for all patients. Phase 1 was the preoperative evaluation phase. Phase 2 (active rest phase) was the first 6 weeks after surgery. During phase 3 (minimal movement phase, 6-12 weeks) pelvic tilt exercises initiated. In phase 4 (dynamic phase, 3-6 months) dynamic lumbar stabilization exercises were started. Phase 5 (return to sports phase) began after the 6th month. The primary outcome criteria were the Visual Analogue Pain Score (VAS) and the Oswestry Disability Index (ODI). Patients were evaluated preoperatively, postoperative 3rd, 12th and 24th months.

RESULTS: The mean preoperative VAS and ODI scores were 7.52±0.97 and 60.96±8.74, respectively. During the 3rd month, VAS and ODI scores decreased to 2.62±1.05 and 26.2±7.93, respectively. VAS and ODI scores continued to decrease during the 12th month after surgery to 1.4±0.81 and 13.72±6.68, respectively. At the last follow-up (mean 34.1 months) the VAS and ODI scores were found to be 0.68±0.62 and 7.88±3.32, respectively. (p=0.0001).

CONCLUSION: The protocol was designed for a postoperative rehabilitation program after PTDS surgery for patients with lumbar degenerative disc disease. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and the presented rehabilitation program. Keywords : Dynamic lumbar stabilization, Posterior transpedicular dynamic stabilization, Exercise after spine surgery, Rehabilitation after spine surgery, Degenerative disc disease