ORIJINAL ARAŞTIRMA
Başarısız Bel Cerrahisi Sendromunda Fizik Tedavi ve Kor Stabilizasyon Egzersizlerinin Etkisi
The Effect of Physical Therapy and Core Stabilization Exercises in Failed Back Surgery Syndrome
Received Date : 18 May 2021
Accepted Date : 17 Nov 2021
Available Online : 02 Dec 2021
Sezin SOLUMa, Lale ALTANb, Meliha KASAPOĞLU AKSOYc
aClinic of Physical Medicine and Rehabilitation, Kestel State Hospital, Bursa, TURKEY
bDepartment of Physical Medicine and Rehabilitation, Bursa Uludağ University Faculty of Medicine, Bursa, TURKEY
cDepartment of Physical Medicine and Rehabilitation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, TURKEY
Doi: 10.31609/jpmrs.2021-84534 - Makale Dili: EN
J PMR Sci. 2022;25(1):89-99
ÖZET
Amaç: Başarısız bel cerrahisi sendromu (BBCS), görülme sıklığı
gittikçe artan önemli bir medikal ve sosyoekonomik durumdur. Çalışmamızın
amacı, BBCS hastalarında lomber kor stabilizasyon
egzersizleriyle kombine edilen transkutanöz elektriksel sinir stimülasyonu
[transcutaneous electrical nerve stimulation (TENS)] ve “hotpack”
tedavisinin; ağrı, fonksiyon ve yaşam kalitesi üzerine etkisini
araştırmaktır. Gereç ve Yöntemler: Çalışmaya geçirilmiş lomber
omurga ameliyatı sonrası devam eden sırt ve/veya bacak ağrısı şikâyeti
olan 50 hasta dâhil edildi. Hastalar, rastgele sayılar tablosu kullanılarak
2 gruba ayrıldı. Grup 1’de lomber bölgeye TENS ve “hot-pack” uygulanarak
toplam 20 seans lomber kor stabilizasyon egzersizleri yapıldı.
Kontrol grubunda (Grup 2), hastalar yukarıdaki terapi veya egzersiz
programlarından hiçbirini almadı. Kontrol grubundaki hastalar, etik
kurul kararı ile bekleme listesine alındı. Çalışma bitiminde bu hastalara
aynı tedavi uygulandı. Tüm hastalar, çalışma başlangıcından önce
ve 4 ve 12 hafta sonra vizüel analog skala (VAS), Oswestry Özürlülük
İndeksi (Oswestry Disability İndex (ODİ), Kısa Form-36 [Short Form-
36 (SF-36)] ile değerlendirildi. Bulgular: İki grubun karşılaştırılmasında,
Grup 1’de VAS ve ODİ parametrelerinde hem 4 (p<0,001) hem
de 12. (VAS p<0,001-ODİ p=0,004) haftada önemli ölçüde daha iyi
gelişme saptandı. SF-36 alt parametrelerinde ise 4. haftada fiziksel rol,
sosyal işlevsellik, duygusal rol ve zihinsel sağlık dışındaki parametrelerde
ve 12. haftada duygusal rol, akıl sağlığı ve zihinsel bileşen hariç
tüm parametrelerde Grup 1’de iyileşme daha iyi olarak gözlendi.
Sonuç: Çalışmamızın sonuçları, BBCS’li hastalarda fizik tedavi ve kor
stabilizasyon egzersizlerinin ağrı, fonksiyonel durum ve yaşam kalitesi
üzerinde olumlu etkilerinin olduğunu göstermiştir.
Anahtar Kelimeler: Başarısız bel cerrahisi sendromu; fizik tedavi; kor stabilizasyon egzersizleri; yaşam kalitesi
ABSTRACT
Objective: Failed back surgery syndrome (FBSS) has
risen steadily worldwide, it has become an important medical and socioeconomic
problem. The purpose of our study was to investigate the
effect of a combination of lumbar core stabilization exercises, transcutaneous
electrical nerve stimulation (TENS) and hot-pack application
on pain, function, and quality of life in FBSS patients. Material and
Methods: Fifty patients with the complaint of back and/or leg pain that
persisted after previous lumbar spine surgery were included in the
study. The patiets were divided into 2 groups using the random numbers
table. In Group 1, TENS and hot-pack were applied over the lumbar
region and performed lumbar stabilization exercises, for a total of
20 sessions. In the control group (Group 2), the patients received none
of the above therapy or exercise program. Patients in the control group
were placed on the waiting list because of the ethics commitee desicion.
At the end of the study, the same treatment was applied to these
patients. All patients were evaluated with visual analogue scale (VAS),
Oswestry Disability Index (ODI), Short Form-36 (SF-36) before, and
4 and 12 weeks after the start of the study. Results: Comparison of the
2 groups showed significantly better improvement in Group 1 for the
parameters of VAS and ODI and both at 4th (p<0.001) and 12th (VAS
p<0.001-ODI p=0.004) weeks. As for the SF-36 sub parameters; improvement
was superior in Group 1 for all but physical role, social functionality,
emotional role, and mental health at 4 weeks, and for all but
emotional role, mental health, and mental component at 12 weeks.
Conclusion: The results of our study showed that physical therapy and
core stabilization exercises have positive effects on pain, functional status
and quality of life in patients with BBCS.
Keywords: Failed back surgery syndrome; physical therapy; core stabilization exercises; quality of life
REFERENCES
- North RB, Campbell JN, James CS, et al. Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery. 1991;28:685-90; discus sion 690-1. [Crossref] [PubMed]
- Raffo C, Wiesel S, Lauerman W. Determining reasons for failed lumbar spine surgery. In: Frymoyer A, editor. The Adult Spine. Philadelphia: Lippincott-Raven; 2003. p.945-54.
- Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016;9:979-87. [Crossref] [PubMed] [PMC]
- Zeidman SM. Failed Back Surgery Syndrome. In: Batjer HH, Loftus CM, eds. Textbook of Neurological Surgery. Vol. 2. Philadelphia: Lippincott Williams&Wilkins; 2003. p.1668-76. [Link]
- Sebaaly A, Lahoud MJ, Rizkallah M, et al. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J. 2018; 12:574-85. [Crossref] [PubMed] [PMC]
- McCracken LM, Turk DC. Behavioral and cognitive-behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process. Spine (Phila Pa 1976). 2002; 27:2564-73. [Crossref] [PubMed]
- Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011;12:577-606. [Crossref] [PubMed]
- Miller B, Gatchel RJ, Lou L, et al. Interdisciplinary treatment of failed back surgery syndrome (FBSS): a comparison of FBSS and non-FBSS patients. Pain Pract. 2005;5:190-202. [Crossref] [PubMed]
- Daniell JR, Osti OL. Failed back surgery syndrome: a review article. Asian Spine J. 2018; 12:372-9. [Crossref] [PubMed] [PMC]
- Franklin GM, Haug J, Heyer NJ, et al. Outcome of lumbar fusion in Washington State workers' compensation. Spine (Phila Pa 1976). 1994;19:1897-903; discussion 1904. [Crossref] [PubMed]
- Amirdelfan K, Webster L, Poree L, et al. Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine (Phila Pa 1976). 2017;42 Suppl 14:S41-S52. [Crossref] [PubMed]
- Reeves JL 2nd, Graff-Radford SB, Shipman D. The effects of transcutaneous electrical nerve stimulation on experimental pain and sympathetic nervous system response. Pain Med. 2004;5:150-61. [Crossref] [PubMed]
- Searle A, Spink M, Ho A, et al. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29:1155-67. [Crossref] [PubMed]
- Akuthota V, Ferreiro A, Moore T, et al. Core stability exercise principles. Curr Sports Med Rep. 2008;7:39-44. [Crossref] [PubMed]
- Häkkinen A, Ylinen J, Kautiainen H, et al. 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. 2005;86:865-70. [Crossref] [PubMed]
- The McGill's text. Low Back Disorders-Evidence-Based Prevention and Rehabilitation. 2nd ed. Champaign (IL): Human Kinetics; 2007. [Link]
- Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. [Crossref] [PubMed]
- Ceran F, Ozcan A. The relationship of the Functional Rating Index with disability, pain, and quality of life in patients with low back pain. Med Sci Monit. 2006;12:CR435-9. [PubMed]
- Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976). 2004;29:581-5; discussion 585. [Crossref] [PubMed]
- Ware JE Jr. SF-36 health survey update. Spine (Phila Pa 1976). 2000;25:3130-9. [Crossref] [PubMed]
- Koçyiğit H, Aydemir Ö, Fişek G ve ark. [Reliability and validity of the Turkish Version of Short Form-36 (SF-36)]. İlaç ve Tedavi Dergisi. 1999;12:102-6. [Link]
- Timm KE. A randomized-control study of active and passive treatments for chronic low back pain following L5 laminectomy. J Orthop Sports Phys Ther. 1994;20:276-86. [Crossref] [PubMed]
- Kjellby-Wendt G, Styf J. Early active training after lumbar discectomy. A prospective, randomized, and controlled study. Spine (Phila Pa 1976). 1998;23:2345-51. [Crossref] [PubMed]
- Danielsen JM, Johnsen R, Kibsgaard SK, et al. Early aggressive exercise for postoperative rehabilitation after discectomy. Spine (Phila Pa 1976). 2000;25:1015-20. [Crossref] [PubMed]
- Filiz M, Cakmak A, Ozcan E. The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study. Clin Rehabil. 2005;19:4-11. [Crossref] [PubMed]
- Yolgösteren E, Külekçioğlu S. The effectiveness of balneotherapy and thermal aquatic exercise in postoperative persistent lumbar pain syndrome. Int J Biometeorol. 2021;65:2137-45. [Crossref] [PubMed]
- Machado LA, de Souza Mv, Ferreira PH, et al. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine (Phila Pa 1976). 2006;31:E254-62. [Crossref] [PubMed]
- Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142:776-85. [Crossref] [PubMed]
- Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13:477-85. [Crossref] [PubMed] [PMC]
- Saal JA. Dynamic muscular stabilization in the nonoperative treatment of lumbar pain syndromes. Orthop Rev. 1990;19:691-700. [PubMed]
- Manniche C, Lundberg E, Christensen I, et al. Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain. 1991;47: 53-63. [Crossref] [PubMed]
- Ozan E, Adıbelli Z, Oztekin O, et al. Evaluation of facet joint arthrosis in stenotic and normal lumbar spines with MRI. J Clin Anal Med. 2014;5:503-6. [Crossref]
- Yílmaz F, Yílmaz A, Merdol F, et al. Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy. J Rehabil Med. 2003; 35:163-7. [Crossref] [PubMed]
- Karahan AY, Sahin N, Baskent A. Comparison of effectiveness of different exercise programs in treatment of failed back surgery syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil. 2016. [Crossref] [PubMed]
- Rainville J, Hartigan C, Martinez E, et al. Exercise as a treatment for chronic low back pain. Spine J. 2004;4:106-15. [Crossref] [PubMed]
- Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine (Phila Pa 1976). 1987;12:S1-59. [Crossref] [PubMed]
- Jauregui JJ, Cherian JJ, Gwam CU, et al. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surg Technol Int. 2016;28:296-302. [PubMed]
- Shokrzadeh A, Seddighi A, Seddighi AS. Therapeutic results of transcutaneous electrical nerve stimulation in post laminectomy syndrome. Global Journal of Health Science. 2010;2:137-41. [Crossref]
- Lehmann JF, Lateur JB. Therapeutic heat. In: Lehmann JF, editor. Therapeutic Heat and Cold. 4th ed. Baltimore: Williams and Wilkins. 1990. p.93-113.
- Mayer JM, Ralph L, Look M, et al. Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. Spine J. 2005;5:395-403. [Crossref] [PubMed]
- Freiwald J, Hoppe MW, Beermann W, et al. Effects of supplemental heat therapy in multimodal treated chronic low back pain patients on strength and flexibility. Clin Biomech (Bristol, Avon). 2018;57:107-13. [Crossref] [PubMed]
- Lewis SE, Holmes PS, Woby SR, et al. Short-term effect of superficial heat treatment on paraspinal muscle activity, stature recovery, and psychological factors in patients with chronic low back pain. Arch Phys Med Rehabil. 2012;93:367-72. [Crossref] [PubMed]
- Shaughnessy M, Caulfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehabil Res. 2004;27:297-301. [Crossref] [PubMed]
- Takahashi N, Kikuchi S, Konno S, et al. Discrepancy between disability and the severity of low back pain: demographic, psychologic, and employment-related factors. Spine (Phila Pa 1976). 2006;31:931-9; discussion 940. [Crossref] [PubMed]
- Claiborne N, Vanderburgh H, Crause TM, et al. Measuring quality oflife changes in individuals with chronic low back conditions: a back education program evaluation. Evaluat Prog Plan. 2002;25:61-70. [Crossref]