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[Postoperative treatment for lumbar disc herniation during rehabilitation. Systematic review].

UNLABELLED
Various programs and interventions are available for the rehabilitation of patients who have undergone surgery for symptomatic lumbar disc herniation (LDH). Our aim is to determine the value of the different rehabilitation interventions included in the postoperative treatment of patients with symptomatic LDH.


MATERIAL AND METHODS
Systematic review. Search in electronic data bases--from January 2000 to October 2012. Two independent reviewers certified in the use of the PEDro (Physiotherapy Evidence Data Base) scale assessed the clinical trials included in the final version; only those with high methodological quality were included. A third reviewer acted as arbitrator in case of discrepancy between reviewers. The reviewers were blinded to the authors, institutions and journals to increase the precision of their ratings and the inter-reviewer validity.


RESULTS
Fifteen clinical trials were reviewed by the reviewers; 8 (53.3%) were considered as having a high methodological quality (average of 7.7/10). Were randomized 1099 participants to different treatment groups. It was not possible to conduct a meta-analysis with the clinical trial data due to the multiple interventions and outcome measures used.


CONCLUSIONS
An immediate rehabilitation program is recommended in patients undergoing microiskectomy for the first time. Cognitive intervention with positive reinforcement together with exercise is an effective treatment. It is even considered as an alternative to vertebral fusion in patients who underwent LDH surgery with symptom recurrence after the first surgery. The results of early postoperative activity are usually excellent and involve no complications. The number and the methodological quality of the clinical trials on this topic need to be increased to justify the usefulness of these interventions in the daily clinical practice.