The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review

Marcella Madera Department of Surgery and Perioperative Care, The University of Texas Dell Medical School;

Search for other papers by Marcella Madera in
jns
Google Scholar
PubMed
Close
 MD
,
Jeremy Brady Rehabilitation Service and

Search for other papers by Jeremy Brady in
jns
Google Scholar
PubMed
Close
 DPT
,
Sylvia Deily Rehabilitation Service and

Search for other papers by Sylvia Deily in
jns
Google Scholar
PubMed
Close
 DC
,
Trent McGinty Rehabilitation Service and

Search for other papers by Trent McGinty in
jns
Google Scholar
PubMed
Close
 DPT
,
Lee Moroz Physical Medicine & Rehabilitation and

Search for other papers by Lee Moroz in
jns
Google Scholar
PubMed
Close
 MD
,
Devender Singh Research, Seton Spine & Scoliosis Center, Austin, Texas

Search for other papers by Devender Singh in
jns
Google Scholar
PubMed
Close
 PhD
,
George Tipton Orthopaedic Spine Surgery, Seton Spine & Rehabilitation; and

Search for other papers by George Tipton in
jns
Google Scholar
PubMed
Close
 MD
, and
Eeric Truumees Department of Surgery and Perioperative Care, The University of Texas Dell Medical School;

Search for other papers by Eeric Truumees in
jns
Google Scholar
PubMed
Close
 MD
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $392.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $392.00
USD  $636.00
Print or Print + Online Sign in

OBJECTIVE

The purpose of this study was to provide a systematic and comprehensive review of the existing literature regarding postfusion rehabilitation.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an exhaustive review of multiple electronic databases. Potential articles were screened using inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data fields, including study quality indicators such as level of evidence and availability of accepted patient-reported outcomes measures. These findings were synthesized in a narrative format. A third author resolved disagreements regarding the inclusion of a study.

RESULTS

Twenty-one articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation, the need for rehabilitation relative to surgery-related morbidity, rehabilitation's relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the 12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start. Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade evidence. In these cases, the authors used “best evidence available” to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion rehabilitation remains elusive but, using the data available, the authors have crafted recommendations and a model protocol, which is currently undergoing prospective study.

CONCLUSIONS

Rehabilitation has long been a common feature in the postoperative management of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for future postoperative lumbar fusion rehabilitation research.

ABBREVIATIONS

CBT = cognitive behavioral therapy; LOE = level of evidence; LOS = length of stay; NASS = North American Spine Society; ODI = Oswestry Disability Index; ROM = range of motion.
  • Collapse
  • Expand
  • 1

    Abbaspoor Z, Akbari M, Najar S: Effect of foot and hand massage in post-cesarean section pain control: a randomized control trial. Pain Manag Nurs 15:132136, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Abbott AD, Tyni-Lenné R, Hedlund R: Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Spine (Phila Pa 1976) 35:848857, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Abbott AD, Tyni-Lenné R, Hedlund R: The influence of psychological factors on preoperative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy 96:213221, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Andersen T, Christensen FB, Egund N, Ernst C, Fruensgaard S, Østergaard J, et al.: The effect of electrical stimulation on lumbar spinal fusion in older patients: a randomized, controlled, multi-center trial: part 2: fusion rates. Spine (Phila Pa 1976) 34:22482253, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Archer KR, Motzny N, Abraham CM, Yaffe D, Seebach CL, Devin CJ, et al.: Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: a case series. Phys Ther 93:11301139, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Archer KR, Seebach CL, Mathis SL, Riley LH III, Wegener ST: Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions. Spine J 14:759767, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, et al.: Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Complement Ther Clin Pract 16:7075, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Biering-Sørensen F: Physical measurements as risk indicators for low-back trouble over a one-year period. Spine (Phila Pa 1976) 9:106119, 1984

  • 9

    Brennan GP, Shultz BB, Hood RS, Zahniser JC, Johnson SC, Gerber AH: The effects of aerobic exercise after lumbar microdiscectomy. Spine (Phila Pa 1976) 19:735739, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Brox JI, Nygaard ØP, Holm I, Keller A, Ingebrigtsen T, Reikerås O: Four-year follow-up of surgical versus nonsurgical therapy for chronic low back pain. Ann Rheum Dis 69:16431648, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Brox JI, Reikerås O, Nygaard Ø, Sørensen R, Indahl A, Holm I, et al.: Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122:145155, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A, et al.: Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine (Phila Pa 1976) 28:19131921, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Brox JI, Storheim K, Holm I, Friis A, Reikerås O: Disability, pain, psychological factors and physical performance in healthy controls, patients with sub-acute and chronic low back pain: a case-control study. J Rehabil Med 37:9599, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Castellote-Caballero Y, Valenza MC, Martín-Martín L, Cabrera-Martos I, Puentedura EJ, Fernández-de-Las-Peñas C: Effects of a neurodynamic sliding technique on hamstring flexibility in healthy male soccer players. A pilot study. Phys Ther Sport 14:156162, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, et al.: Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil 24:2636, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Christensen FB, Laurberg I, Bünger CE: Importance of the back-café concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up. Spine (Phila Pa 1976) 28:25612569, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Cowan JA Jr, Dimick JB, Wainess R, Upchurch GR Jr, Chandler WF, La Marca F: Changes in the utilization of spinal fusion in the United States. Neurosurgery 59:1520, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Cutshall SM, Wentworth LJ, Engen D, Sundt TM, Kelly RF, Bauer BA: Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study. Complement Ther Clin Pract 16:9295, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Deyo RA, Mirza SK: The case for restraint in spinal surgery: does quality management have a role to play?. Eur Spine J 18:Suppl 3 331337, 2009

  • 20

    Egbert LD, Battit GE, Welch CE, Bartlett MK: Reduction of postoperative pain by encouragement and instruction of patients. A study of doctor-patient rapport. N Engl J Med 270:825827, 1964

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    El Ouaaid Z, Shirazi-Adl A, Plamondon A, Larivière C: Trunk strength, muscle activity and spinal loads in maximum isometric flexion and extension exertions: a combined in vivo-computational study. J Biomech 46:22282235, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Ellis R, Hing W, Dilley A, McNair P: Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique. Ultrasound Med Biol 34:12091216, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Ellis RF, Hing WA: Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Manual Manip Ther 16:822, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R: Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Farin E, Gramm L, Schmidt E: The patient-physician relationship in patients with chronic low back pain as a predictor of outcomes after rehabilitation. J Behav Med 36:246258, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Flanigan DC, Everhart JS, Glassman AH: Psychological factors affecting rehabilitation and outcomes following elective orthopaedic surgery. J Am Acad Orthop Surg 23:563570, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Fritz JM, Lurie JD, Zhao W, Whitman JM, Delitto A, Brennan GP, et al.: Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. Spine J 14:16111621, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Froholdt A, Holm I, Keller A, Gunderson RB, Reikeraas O, Brox JI: No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises. Spine J 11:718725, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Froholdt A, Reikeraas O, Holm I, Keller A, Brox JI: No difference in 9-year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises. Eur Spine J 21:25312538, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Hägg O, Fritzell P, Ekselius L, Nordwall A: Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish Lumbar Spine Study. Eur Spine J 12:2233, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Hägg O, Fritzell P, Nordwall A: The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:1220, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Häkkinen A, Ylinen J, Kautiainen H, Tarvainen U, Kiviranta I: Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up. Arch Phys Med Rehabil 86:865870, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Hidalgo B, Detrembleur C, Hall T, Mahaudens P, Nielens H: The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews. J Manual Manip Ther 22:5974, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Kaiser MG, Eck JC, Groff MW, Watters WC III, Dailey AT, Resnick DK, et al.: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology. J Neurosurg Spine 21:26, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikerås O: Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine (Phila Pa 1976) 29:38, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Kepler CK, Vaccaro AR, Hilibrand AS, Anderson DG, Rihn JA, Albert TJ, et al.: National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 39:15841589, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Kjellby-Wendt G, Styf J, Carlsson SG: Early active rehabilitation after surgery for lumbar disc herniation: a prospective, randomized study of psychometric assessment in 50 patients. Acta Orthop Scand 72:518524, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Kramer M, Katzmaier P, Eisele R, Ebert V, Kinzl L, Hartwig E: Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine. Eur Spine J 10:414420, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Kramer M, Völker HU, Weikert E, Katzmaier P, Sterk J, Willy C, et al.: Simultaneous measurement of intramuscular pressure and surface electromyography of the multifidus muscle. Eur Spine J 13:530536, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    LaCaille RA, DeBerard MS, Masters KS, Colledge AL, Bacon W: Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion. Spine J 5:7178, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Le Blanc-Louvry I, Costaglioli B, Boulon C, Leroi AM, Ducrotte P: Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg 6:4349, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB: Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21:22652270, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Lurie JD, Tosteson TD, Tosteson A, Abdu WA, Zhao W, Morgan TS, et al.: Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 40:6376, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Mannion AF, Brox JI, Fairbank JC: Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 13:14381448, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Mannion AF, Denzler R, Dvorak J, Müntener M, Grob D: A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J 16:11011117, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Mannion AF, Müntener M, Taimela S, Dvorak J: Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one-year follow-up. Rheumatology (Oxford) 40:772778, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Millan M, Leboeuf-Yde C, Budgell B, Descarreaux M, Amorim MA: The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review. Chiropr Man Therap 20:23, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    Mirza SK, Deyo RA: Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine (Phila Pa 1976) 32:816823, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Moffett JK, Torgerson D, Bell-Syer S, Jackson D, Llewlyn-Phillips H, Farrin A, et al.: Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ 319:279283, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50

    Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336341, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Monticone M, Ferrante S, Teli M, Rocca B, Foti C, Lovi A, et al.: Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial. Eur Spine J 23:8795, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52

    Nielsen PR, Andreasen J, Asmussen M, Tønnesen H: Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine. BMC Health Serv Res 8:209, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53

    Nielsen PR, Jørgensen LD, Dahl B, Pedersen T, Tønnesen H: Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil 24:137148, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54

    Oestergaard LG, Christensen FB, Nielsen CV, Bünger CE, Fruensgaard S, Sogaard R: Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial. Spine (Phila Pa 1976) 38:19791985, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55

    Oestergaard LG, Nielsen CV, Bünger CE, Sogaard R, Fruensgaard S, Helmig P, et al.: The effect of early initiation of rehabilitation after lumbar spinal fusion: a randomized clinical study. Spine (Phila Pa 1976) 37:18031809, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56

    Oestergaard LG, Nielsen CV, Bünger CE, Svidt K, Christensen FB: The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study. Eur Spine J 22:18841890, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57

    Ostelo RW, de Vet HC, Waddell G, Kerckhoffs MR, Leffers P, van Tulder M: Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the Cochrane collaboration. Spine (Phila Pa 1976) 28:209218, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58

    Poitras S, Rossignol M, Dionne C, Tousignant M, Truchon M, Arsenault B, et al.: An interdisciplinary clinical practice model for the management of low-back pain in primary care: the CLIP project. BMC Musculoskelet Disord 9:54, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59

    Rosenberger PH, Jokl P, Cameron A, Ickovics JR: Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes. Arthroscopy 21:562569, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60

    Sawyer MW: The role of the physical therapist before and after lumbar spine surgery. Orthop Clin North Am 14:649659, 1983

  • 61

    Scrimshaw SV, Maher CG: Randomized controlled trial of neural mobilization after spinal surgery. Spine (Phila Pa 1976) 26:26472652, 2001

  • 62

    Skolasky RL, Mackenzie EJ, Wegener ST, Riley LH III: Patient activation and functional recovery in persons undergoing spine surgery. J Bone Joint Surg Am 93:16651671, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63

    Tarnanen S, Neva MH, Dekker J, Häkkinen K, Vihtonen K, Pekkanen L, et al.: Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol. BMC Musculoskelet Disord 13:123, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64

    Tarnanen S, Neva MH, Kautiainen H, Ylinen J, Pekkanen L, Kaistila T, et al.: The early changes in trunk muscle strength and disability following lumbar spine fusion. Disabil Rehabil 35:134139, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65

    Tarnanen SP, Neva MH, Häkkinen K, Kankaanpää M, Ylinen J, Kraemer WJ, et al.: Neutral spine control exercises in rehabilitation after lumbar spine fusion. J Strength Cond Res 28:20182025, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66

    Timm KE: A randomized-control study of active and passive treatments for chronic low back pain following L5 laminectomy. J Orthop Sports Phys Ther 20:276286, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67

    Virk SS, Niedermeier S, Yu E, Khan SN: Adjacent segment disease. Orthopedics 37:547555, 2014

  • 68

    Waschke A, Hartmann C, Walter J, Dünisch P, Wahnschaff F, Kalff R, et al.: Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients. Acta Neurochir (Wien) 156:235244, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69

    Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, et al.: Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:12951304, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 70

    Willems P: Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion. Acta Orthop Suppl 84:135, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 3718 3718 520
Full Text Views 23657 1718 16
PDF Downloads 23249 1897 26
EPUB Downloads 0 0 0