Authors (including presenting author) :
Yung JMW(1), Ngan YK(1), Lee CH(1) , Lai WC(1), Tsang NC(1), Wan S(1), Kwong S(2), Yeung SF(1), Lui WM (2) , Mok WY(3), Yam SK(3)
Affiliation :
(1) Physiotherapy Department, PYNEH, (2)Physiotherapy Department, RTSKH, (3)O&T Department, HKEC
Introduction :
Lumbar decompression surgery is a common procedure used to treat various lumbar spinal pathologies. The type of surgery performed depends on the diagnosis. Physiotherapists have the role of case managers to provide care throughout the patient journey.
Objectives :
1. To triage spinal referrals and provide fast-track service
2. To provide physiotherapy assessment and intervention pre- and post-surgery
3. To evaluate functional outcomes after surgery
Methodology :
From January 2016 to May 2022, 187 patients (mean age 64 ± 10.5, 51.3% male) who underwent lumbar surgery for pathologies such as spinal radiculopathy and claudication were assessed preoperatively, 6- month and 2-year postoperatively.
Types of spinal decompression surgeries included spinal fusion and decompression. Outcome measures included Oswestry Disability Index (ODI), 6 Minute Walk Test (6MWT), and 30 Minutes Standing Tolerance Test (30MSTT) were used to evaluate changes in subjective functional disability level, walking tolerance, and standing tolerance over time. Physiotherapy interventions included core and limb strengthening, activity modification, functional training, neural mobilization, and postural alignment training.
Result & Outcome :
There was a statistically significant improvement in ODI for postoperative 6 months (fusion: from 48.1 % to 27.2 %; decompression: 45.4% to 29.7%, both p<0.001) and 2 years (fusion: from 48.1% to 26.5%; decompression 45.4% to 26.5%, both p<0.001). There was a significant improvement in 30MSTT (postoperative 6 months: from 22.5 to 26.9 minutes p<0.001;postoperative 2 years: 22.5 to 27.1 minutes, p<0.001) in fusion group. There was no significant improvement in decompression group (postoperative 6 months: p=0.077; postoperative 2 years: p=0.039).
There was statistically significant improvement in 6MWT postoperatively in instrumental group (6 months: 307.6m to 333.5m, p=0.001; postoperative 2 years: 307.6m to 345.2m, p<0.001) but not in non-instrumental group (postoperative 6 months: p=0.288>0.017; postoperative 2 years: p=0.069>0.017).
In conclusion, both fusion and decompression surgery significantly improved subjective functional performance in ODI in both 6 months and 2 years. Additionally, standing and walking abilities following instrumentation surgery in 6 months and 2 years were significantly improved. Evidence supported the collaborative program of the Spine Triage Clinic in managing patients who underwent lumbar surgeries, which enhanced physical and locomotor functions and quality of life.
