After Spinal Surgery

After a discectomy, early mobilisation and a graded return to activity are appropriate and recovery is relatively quick. After a decompression, walking tolerance is the main target. After a fusion, there is a protected period while the fusion consolidates and loading is restricted for months.

Applying a discectomy protocol after a fusion risks the construct. This is why we ask for the operation note and the surgeon's protocol in writing before admission rather than inferring it from the procedure name.

After lumbar disc surgery, exercise programmes starting four to six weeks after the operation reduce pain and disability faster than no treatment, and higher-intensity programmes do slightly better than low-intensity ones, but the evidence is of low or very low quality 2. Programmes started immediately after surgery have not proved better than their comparison treatments, and no trial has linked exercise to more reoperations 2.

Whether prehabilitation before planned lumbar surgery improves recovery is uncertain: a 2021 meta-analysis found that preoperative cognitive behavioural programmes added nothing to usual care, and only one trial of preoperative exercise was available, showing a short-term benefit 5.

Early walking progression, trunk and hip strengthening within the permitted range, movement retraining for daily tasks — getting out of bed, lifting, bending — and graded return to work and activity.

Fear of movement is common and specifically addressed. Many patients protect the back long after it is necessary, and that avoidance becomes the limiting factor rather than the surgery.

New or worsening leg weakness, new numbness around the groin, loss of bladder or bowel control, wound discharge, or fever. These are surgical concerns and need same-day contact with the operating team.

Increasing rather than decreasing pain after an initial improvement is also worth reporting rather than working through.

What was fused, what was decompressed, whether instrumentation was used and what the weight-bearing and bending restrictions are — these govern the first phase entirely.

Where the surgeon is abroad we work to their written protocol and report back. Where a restriction is unclear we ask rather than assume, because the cost of guessing falls on the surgery.

After decompression for lumbar spinal stenosis, yes, modestly. A Cochrane review of three trials with 373 patients found moderate-quality evidence that active rehabilitation improves function and back pain more than usual care, both within six months and at 12 months, when leg pain was also lower 3. The authors judged the effects small to medium, and no relevant adverse events were reported 3.

After lumbar fusion the evidence is thinner. Two small trials of programmes combining exercise with cognitive behavioural therapy found less disability and less fear-avoidance behaviour than usual care, in the short and the longer term, but the evidence is of low quality 4. After fusion, any programme also has to work within the restrictions the surgeon sets while the bone heals.