Lumbar Spine Procedures & Rehab

• The presentation provides an overview of common lumbar spine procedures and clinical pearls for rehab considerations

Epidural Steroid Injection

• Targeting nerve-related pain by injecting into the epidural space to affect nerve roots
• According to a systematic review in 2020, an epidural steroid injection is only marginally more effective than a placebo in reducing pain
• According to a meta-analysis study in 2020, there is a significant difference in pain relief between injection and other conservative treatments
• There is no significant difference in functional improvement
• Rehab considerations generally instruct patients to avoid intense activity for 24-48 hours following the injection
• There are no specific limitations in motion or strength training
• Patient pain, abilities, and goals provide guidance for interventions

Facet Joint Injection

• This procedure targets the facet joints, which can be a source of mechanical back pain
• In 2020, it was stated that the clinical evidence for the efficacy of facet joint injection is considered limited
• Rehab considerations are the same as epidural injections
• More focus may be put on flexion biased movements initially
• Restoring extension is key

Radiofrequency Ablation (RFA)

• Targets medial branch nerves around the facets
• Nerve endings are destroyed to reduce nociceptive signal
• A physician first performs a medial branch block to test for potential efficacy
• Evidence indicates good efficacy for pain relief, especially if the medial branch block was effective
• Rehab considerations are generally the same as injections, but a physician protocol might dictate a longer period of relative rest
• Manage post-intervention pain and soreness
• Re-introduce movement and progress according to patient tolerance

Discectomy

• This surgery involves removing part of a disc
• It is done to relieve pressure on a nerve root
• Effective for reducing leg pain and neurological deficit
• Mixed efficacy for back pain
• Rehab considerations include managing post-operative pain
• There isn't very many movement or weight limitations imposed
• Patient's pain, abilities, and goals provide guidance for interventions

Laminectomy

• This surgery involves removing a lamina, including the spinous process
• It is done to decompress the central canal
• It is common for spinal stenosis
• Multiple levels can indicate fusion
• Rehab considerations include initially limitations into extension
• Focus on flexion-biased exercises
• Hip mobility exercises
• Core strengthening for the anterior and posterior chain of muscles
• Limit end-range strengthening for 8-12 week

Lumbar Fusion

• According to a clinical perspective of a study in 2018, there is no clinical benefit for patients with back pain associated with degeneration from the fusion
• There is unclear benefit for patients with spondylolisthesis
• It can improve mobility and neurological outcome for metastatic carcinoma patients with spinal cord compromise
• Rehab considerations include most surgeons having a specific protocol
• It can start immediately afterward or wait until 2-3 months after
• There is generally no Bending, Lifting, and Twisting (BLT) for anywhere from 6-12 weeks
• Hip mobility is important
• Core and hip strengthening is also considered in rehab
• Patient tolerance, abilities, and goals guide intensity

Overview of common lumbar spine procedures like epidural steroid injection and facet joint injection. Rehab considerations after the injection including limitations in motion, strength training and intense activity are discussed. Patient abilities and goals provide guidance for interventions.