Survey of postoperative practices for lumbar spinal stenosis surgery among canadian spinal surgeons and rehabilitation professionals

Background: Postoperative rehabilitation for lumbar spine stenosis (LSS) surgery has been shown to improve functional status postoperatively. However, there is a lack of clinical guidelines on postsurgical recommendations, movement restrictions and rehabilitation practices, which can lead to variations in care. The purpose of this study was to describe current postoperative LSS surgery practices of spine surgeons, physiotherapists, and chiropractors in Canada related to movement restrictions, exercise recommendations and rehabilitation. Methods: The cross-sectional online survey was distributed to spine surgeons, physiotherapists and chiropractors through newsletters and emails from professional colleges and associations. The surveys involved 3 clinical vignettes of patients with LSS, each with a different type of surgical intervention. Participants were asked to reflect on the cases and provide information on their postoperative practices. Results: Twenty-six spine surgeons and 151 rehabilitation professionals responded to the survey. Many of the spine surgeons in this study do not (35%) or occasionally refer (27%) their post-LSS surgery patients to outpatient postoperative rehabilitation and do not believe such programs are necessary for all patients (65.4%). There was significant variation on which restrictions should be applied and the length of time that restrictions should be used across all movements and conditions. Rehabilitation professionals observed movement restrictions that aligned with surgeons' recommendations in Cases 1 (decompression) and 3 (long fusion). However, in Case 2 (laminectomy with 1-3 level fusion), they noted more restrictions (eg, pushing, pulling, lifting) than those prescribed by surgeons. The range of exercise recommendations and treatment modalities rehabilitation professionals prescribe vary widely. Conclusions: There is currently wide variation in care, demonstrating the need to build consensus among spine surgeons and rehabilitation professionals regarding the most optimal postoperative management. In addition, the reasoning behind imposed restrictions should be considered along with surgery-specific factors in refining current postoperative care pathways for the studied patient population.