Rehabilitasi post op

spine surgery
Kobal Sangaji
Dokter Spesialis Rehabilitasi Medik
RS Awalbros Pekanbaru
Back / Lumbal

 Anatomy view : tempat tegaknya tubuh

 Fungsi lumbal
 Disabilitas 85% setiap orang menderita nyeri tulang belakang
 Kinesiology
Rehabilitation Principle

• Assess any Abnormality and treat to correct the Abnormality

• MODIFY ACTIVITIES
• CORRECT BIOMECHANICAL ABNORMALITIES
• POSTURAL ASSESSMENT OF FUNCTIONAL POSITIONS
• LIFTING MECHANICS
• CORE STABILITY : LOCAL THEN GLOBAL
• ASSESS / STRETCH TIGHTNESS
• EDUCATION
• HOME EXERCISE REGIME
 FUNCTIONAL STABILITY

NEED TO UTILISE BOTH MUSCLE FORCES AND PASSIVE STRUCTURES TO

DYNAMICALLY STABILISE THE SPINE FUNCTIONALLY

ANY DEFICITS ASSESSED NEED TO BE ADDRESSED IN A REHABILITATION .PLAN

Spine Surgery and Post-Op Rehabilitation
 Increasing rates for many procedures, particular
complex surgery in older patients
 Outcomes are variable
 Failure rates are reported between 10% - 40%
 Utilization and content of post-operative
rehabilitation are inconsistent.
 Evidence-base for post-operative rehabilitation
strategies is sparse
THE RESEARCH
 Alexsiev et al. Function After
Spinal Treatment, Exercise, and
Rehabilitation (FASTER): A Factorial Randomized Trial to
Determine Whether the Functional Outcome of Spinal
Surgery Can Be Improved. Spine 2011: 997-1003

 388 patients undergoing surgery for lateral nerve

root compression or disc prolapse.
 Factorial Randomized Trial
 Factor 1: either 6 weeks of rehabilitation or usual care by
surgeon
 Factor 2: Either an Educational Booklet (“Your Back
Operation”) or usual advice by surgeon
 Alexsiev et al. Function After
Spinal Treatment, Exercise, and
Rehabilitation (FASTER): A Factorial Randomized Trial to
Determine Whether the Functional Outcome of Spinal
Surgery Can Be Improved. Spine 2011: 997-1003

Rehabilitation Intervention:
- Began 6-8 weeks after surgery
- 12 standardized 1-hour classes run by a PT (twice weekly)
- General aerobic fitness, stretching, stability,
strengthening, ergonomic advice, motivation

Education Intervention:
- Given a copy of booklet at hospital discharge
Key themes derived from literature used to develop booklet

Eur Spine J. 2007 Mar; 16(3): 339–346.

 Alexsiev et al. Function After
Spinal Treatment, Exercise, and
Rehabilitation (FASTER): A Factorial Randomized Trial to
Determine Whether the Functional Outcome of Spinal
Surgery Can Be Improved. Spine 2011: 997-1003

Rehabilitation Intervention:
 Of those allocated to rehabilitation – 41% attended no
classes and an additional 16% attended less than half of the
sessions.
 No impact on outcomes except average leg pain

Education Intervention:
- No impact on outcomes
- No interaction effects between treatments
 Mannion AH et al. A randomised controlled trial of post-
operative rehabilitation after surgical decompression of
the lumbar spine. Eur Spine J 2007:16(8):1101-17.

 159 patients with degenerative spine disease (stenosis

or disc disease) scheduled for decompression, age > 45
 Randomized to 1 of 3 treatment groups:
o Self management for 12 weeks (advised to be active and
exercise)
o PT with spine stabilization (2 sessions per week for 12 weeks)
o PT with mixed techniques (2 sessions per week for 12 weeks)
 Mannion AH et al. A randomised controlled trial of post-
operative rehabilitation after surgical decompression of
the lumbar spine. Eur Spine J 2007:16(8):1101-17.

 159 patients with degenerative spine disease (stenosis

or disc disease) scheduled for decompression, age > 45
 Randomized to 1 of 3 treatment groups:
o Self management for 12 weeks (advised to be active and
exercise)
o PT with spine stabilization (2 sessions per week for 12 weeks)
o PT with mixed techniques (2 sessions per week for 12 weeks)
 Mannion AH et al. A randomised controlled trial of post-
operative rehabilitation after surgical decompression of
the lumbar spine. Eur Spine J 2007:16(8):1101-17.

Advising patients to keep active by carrying out the type of

physical activities that they most enjoy appears to be just as
good as administering a supervised rehabilitation program,
and at no cost to the health-care provider.
Initial exercise program

1. Ankle pump
2. Heel slides
3. Abdominal contraction
4. Wall squat
5. Heel raises
6. Straight leg raises
Intermediate exercise program

1. Single knee to chest stretch

2. Hamstring stretch
Advanced exercise program

1. Hip flexor stretch

2. Piriformis stretch
Lumbal stabilization with ball

1. Lying on the floor

2. Sitting on the ball
3. Standing with ball
4. Lying on the floor
 Aerobic exercise

 Static bike for 20-30 menit

 Treadmill 20 – 30 menit
FAQ

 Best exercise is walking that improve blood flow & bring oxygen and nutrient
to spinal muscle
 After decompression 6 minggu tidak boleh angkat berat, cardiovascular
exercise setealah 3-4 minggu, start physical therapy 1 bulan setelah operasi.
6 bulan post op return to sport
 Saraf akan regenerasi 3 minggu setelah operasi
 Nyeri pada ankle bias terjadi pada kasus post op, bila berlanjut selama tiga
bulan maka kemungkinan reassessment ulang
 Post laminectomy syndrome akan menjadi nyeri kronis dan disabilty
Rehabilitasi dan latihan post op spine
surgery
1. Pain control
2. One and one training after surgery
3. Exercise for recovery
4. Education program
Pain control

Acute Back Pain

 Local modalities for pain/spasm
 Encourage non-­‐aggravating movement and exercise Educate / encourage neutral spine
 Manual therapy techniques
 Home exercise
 Back Care advice

SUB-­
‐ACUTE BACK PAIN
 Local modalities for pain/spasm/hypo mobility Restore range with manual therapy and
exercise Core stability regime and upgrade
 Review postures/biomechanics Home exercise / Cardio fitness
Start program rehabilitasi

 Melalui muscle fascilitation yaitu melatih kembali untuk penguatan dan

stabilisasi pada :
1. Otot otot daerah insisi
2. Otot otot yang lemah sebelum dilakukan tindakan operasi
3. Otot otot kecil yang berfungsi stabilisasi pada area tulang belakang
4. Melatih pada otot dan sendi yang lain
Exercise after spine surgery

 Exercise is vital to getting better after spine surgery.

 It is the key to eliminating fatigue, getting patients back to activity safely,
and avoiding re-injury.
 Ultimately, exercise is critical both in helping the body heal from the original
injury and in preventing (or minimizing) future episodes of back pain
Education

 Control regularly
 Do not carry heavy thing
 Proper back mechanic
 Exercise gradually
 Return to work and activity as prescribed by doctor
TERIMA KASIH