Ulyanovsk Medico-biological Journal

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2019-1-17-25

POST-OPERATIVE REHABILITATION FOR PATIENTS WITH DEGENERATIVE DISK DISEASES

 

I.V. Borodulina1, S.O. Arestov2, A.O. Gushcha2, N.G. Badalov1, A.A. Mukhina1

1 National Medical Research Center for Rehabilitation and Balneology, Ministry of Health
of the Russian Federation, Moscow, Russia;

2 Research Center of Neurology, Moscow, Russia

e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Surgical treatment for degenerative disk diseases is widespread today. Surgery is used to decompress neural structures, eliminate pain and symptoms of neurologic impairment. Nevertheless, a successful surgical intervention does not always guarantee a favorable clinical effect, which is associated with various factors: the duration of a disease, compensatory abilities of patients, and their emotional state. Thus, post-operative rehabilitation, based on a multimodal patient-oriented personalized approach, becomes very relevant. Post-operative rehabilitation considers the degree of functional limitation or loss and the impact of situational factors. According to the concept of post-operative rehabilitation as a personalized management strategy, it is advisable to divide patients into the following groups: those who do not have alert complaints or neurological impairment after surgery; those who have chronic pain; those who have residual or persistent neurological impairment. Such an approach allows physicians to suggest an individual program for rehabilitation treatment.

Keywords: postoperative rehabilitation, degenerative disk diseases, multimodal patient-oriented personalized approach.

 

References

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  2. Wagner E.H., Bennett S.M., Austin B.T. Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care. J. Altern. Complement. Med. 2005; 11 (1): 7–15.
  3. Broetz D., Weller M. Physical Therapy for Intervertebral Disk Disease. A Practical Guide to Diagnosis and Treatment. Thieme; 2016. 228.
  4. Richard L. Skolasky, Lee H. Riley III, Anica M. Maggard. Functional recovery in lumbar spine surgery: A controlled trial of health behavior change counseling to improve outcomes. Contemporary Clinical Trials. 2013; 36 (1): 207–217.
  5. Deary V., Chalder T., Share M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clin. Psychol. Rev. 2007; 27 (7): 781–797.
  6. Diagnosis and treatment of degenerative lumbar spinal stenosis. NASS Evidence-Based Clinical Guidelines Committee. North American Spin Society. Evidence-based clinical guidelines for multidisciplinary spine care. 2011.
  7. Long D.M. Decision making in lumbar disk disease. Clin. Neurosurg. 1992; 39: 36–51.
  8. Oosterhuis T., Ostelo R.W., van Dongen J.M. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. J. Phy-
    siother. 2017; 63 (3): 144–153.
  9. Ostelo R.W., de Vet H.C., Berfelo M.W., Kerckhoffs M.R. Effectiveness of behavioral graded activity after first-time lumbar disc surgery: short term results of a randomized controlled trial. European Spine Journal. 2003; 12 (6): 637–644.
  10. Kjellby Wendt G., Styf J. Early active training after lumbar discectomy. A prospective, randomized, and controlled study. Spine. 1999; 23 (21): 2345–2351.
  11. Wilke H.J., Neef P., Caimi M., Hoogland T. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999; 24 (8): 755–762.
  12. Peolsson A., Öberg B., Wibault J. Outcome of physiotherapy after surgery for cervical disc disease:
    a prospective randomised multi-centre trial. BMC Musculoskelet Disord. 2014; 6: 15–34.
  13. McGregor A.H., Dore C.J., Morris T.P., Morris S. ISSLS prize winner: 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; 36 (21): 1711–1720.
  14. Oosterhuis T., Costa L.O., Maher C.G., de Vet H.C. Rehabilitation after lumbar disc surgery. Cochrane Database Syst. Rev. 2014; 14 (3).
  15. Yilmaz F., Yilmaz A., Merdol F., Parlar D. Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy. Journal of Rehabilitation Medicine. 2003; 35: 163–167.
  16. Rushton A., Wright C., Goodwin P. Physiotherapy Rehabilitation Post First Lumbar Discectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The Spine Journal. 2011; 36 (14): 961–972.
  17. Olefirenko V.T. Vodoteplolechenie [Hydrosudotherapy]. Moscow: Meditsina; 1986 (in Russian).
  18. Johansen A., Schirmer H., Stubhaug A., Nielsen C.S. Persistent post-surgical pain sensitivity in the Tromso study: comorbid pain matters. Pain. 2014; 155: 341–348.
  19. Cohen S.P., Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014; 348.
  20. Attala N., Cruccua G., Barona R., Haanpa M. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. European Journal of Neurology. 2010; 17: 1113–1123.
  21. Gilron I., Baley J.M., Tu D., Holdern D.R. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009; 374: 1252–1261.
  22. Attala N., Ayache S.S., Ciampi De Andrade D., Mhalla A. Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy: a randomized sham-controlled comparative study. Pain. 2016; 157 (6): 1224–1231.
  23. Kumru H., Albu S., Vidal J., Tormos J.M. Effectiveness of repetitve transcranial magnetic stimulation in neuropathic pain. Disabil. Rehabil. 2016; 39: 1–11.
  24. Lefaucheur J.P., Drouot X., Menard-Lefaucheur I. Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J. Neurol. Neurosurg. Psychiatry. 2004; 75: 612–616.
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  27. Burki J.R., Omar I., Shah P.J., Hamid R. Long-term urological management in spinal injury units in the U.K. and Eire: a follow-up study. Spinal Cord. 2014; 52 (8): 640–645.
  28. Madersbacher H. Diagnosis of functional neurogenic urination disorders from the urologist's viewpoint. Gynakol. Rundsch. 1980; 20 (suppl. 2): 161–172.
  29. Ahn U.M., Ahn N.U., Buchowski J.M. Cauda equina syndrome secondary to lumbar disc herniation:
    a meta-analysis of surgical outcomes. Spine. 2000; 25 (12): 1515–1522.
  30. Di Benedetto P. Clean intermittent self-catheterization in neuro-urology. Eur. J. Phys. Rehabil. Med. 2011; 47 (4): 651–659.
  31. Vignes J.R., Seze M.D., Dobremez E. Sacral Neuromodulation in Lower Urinary Tract Dysfunction. Advances and Technical Standards in Neurosurgery. 2005; 30: 177–224.
  32. Wong J.J., Côté P., Sutton D.A., Randhawa K. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur. J. Pain. 2017; 21 (2): 201–216.
  33. 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. 2005; 86 (5): 865–870.

 

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DOI 10.34014/2227-1848-2019-1-17-25

УДК 616.711.9

 

ПОСЛЕОПЕРАЦИОННАЯ РЕАБИЛИТАЦИЯ ПРИ ДЕГЕНЕРАТИВНЫХ ЗАБОЛЕВАНИЯХ ПОЗВОНОЧНИКА

 

И.В. Бородулина1, С.О. Арестов2, А.О. Гуща2, Н.Г. Бадалов1, А.А. Мухина1

1 ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава России, г. Москва, Россия;

2 ФГБНУ «Научный центр неврологии», г. Москва, Россия

e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Хирургические методы лечения при дегенеративных заболеваниях позвоночника широко распространены в настоящее время. Оперативное вмешательство применяется с целью декомпрессии невральных структур, устранения болевого синдрома и симптомов неврологического дефицита. Тем не менее успешно проведенная операция не всегда гарантирует благоприятный клинический эффект, что связано с различными факторами: длительностью заболевания, компенсаторными возможностями пациента, а также его эмоциональным состоянием. В связи с этим весьма актуальное значение приобретает процесс послеоперационной реабилитации, который основывается на мультимодальном пациентоориентированном персонализированном подходе с учетом степени ограничения или утраты функции, а также влияния факторов окружения. В соответствии
с концепцией послеоперационной реабилитации как персонализированной стратегии ведения целесообразно принципиальное разделение пациентов на следующие группы: не имеющие активных жалоб или неврологического дефицита после операции; имеющие хронический болевой синдром; имеющие остаточный или стойкий неврологический дефицит. Данная концепция позволяет сформировать индивидуальную программу реабилитационного лечения.

Ключевые слова: послеоперационная реабилитация, дегенеративные поражения позвоночника, мультимодальный пациентоориентированный персонализированный подход.

 

Литература

  1. White Book on Physical and Rehabilitation Medicine (PRM) in Europe. European Physical and Rehabilitation Medicine Bodies Alliance. Eur. J. Phys. Rehabil. Med. 2018; 54 (2).
  2. Wagner E.H., Bennett S.M., Austin B.T. Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care. J. Altern. Complement. Med. 2005; 11 (1): 7–15.
  3. Broetz D., Weller M. Physical Therapy for Intervertebral Disk Disease. A Practical Guide to Diagnosis and Treatment. Thieme; 2016. 228.
  4. Richard L. Skolasky, Lee H. Riley III, Anica M. Maggard. Functional recovery in lumbar spine surgery: A controlled trial of health behavior change counseling to improve outcomes. Contemporary Clinical Trials. 2013; 36 (1): 207–217.
  5. Deary V., Chalder T., Share M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clin. Psychol. Rev. 2007; 27 (7): 781–797.
  6. Diagnosis and treatment of degenerative lumbar spinal stenosis. NASS Evidence-Based Clinical Guidelines Committee. North American Spin Society. Evidence-based clinical guidelines for multidisciplinary spine care. 2011.
  7. Long D.M. Decision making in lumbar disk disease. Clin. Neurosurg. 1992; 39: 36–51.
  8. Oosterhuis T., Ostelo R.W., van Dongen J.M. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. J. Physiother. 2017; 63 (3): 144–153.
  9. Ostelo R.W., de Vet H.C., Berfelo M.W., Kerckhoffs M.R. Effectiveness of behavioral graded activity after first-time lumbar disc surgery: short term results of a randomized controlled trial. European Spine Journal. 2003; 12 (6): 637–644.
  10. Kjellby Wendt G., Styf J. Early active training after lumbar discectomy. A prospective, randomized, and controlled study. Spine. 1999; 23 (21): 2345–2351.
  11. Wilke H.J., Neef P., Caimi M., Hoogland T. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999; 24 (8): 755–762.
  12. Peolsson A., Öberg B., Wibault J. Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial. BMC Musculoskelet Disord. 2014; 6: 15–34.
  13. McGregor A.H., Dore C.J., Morris T.P., Morris S. ISSLS prize winner: 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; 36 (21): 1711–1720.
  14. Oosterhuis T., Costa L.O., Maher C.G., de Vet H.C. Rehabilitation after lumbar disc surgery. Cochrane Database Syst. Rev. 2014; 14 (3).
  15. Yilmaz F., Yilmaz A., Merdol F., Parlar D. Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy. Journal of Rehabilitation Medicine. 2003; 35: 163–167.
  16. Rushton A., Wright C., Goodwin P. Physiotherapy Rehabilitation Post First Lumbar Discectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The Spine Journal. 2011; 36 (14): 961–972.
  17. Олефиренко В.Т. Водотеплолечение. М.: Медицина; 1986.
  18. Johansen A., Schirmer H., Stubhaug A., Nielsen C.S. Persistent post-surgical pain sensitivity in the Tromso study: comorbid pain matters. Pain. 2014; 155: 341–348.
  19. Cohen S.P., Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014; 348.
  20. Attala N., Cruccua G., Barona R., Haanpa M. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. European Journal of Neurology. 2010; 17: 1113–1123.
  21. Gilron I., Baley J.M., Tu D., Holdern D.R. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009; 374: 1252–1261.
  22. Attala N., Ayache S.S., Ciampi De Andrade D., Mhalla A. Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy: a randomized sham-controlled comparative study. Pain. 2016; 157 (6): 1224–1231.
  23. Kumru H., Albu S., Vidal J., Tormos J.M. Effectiveness of repetitve transcranial magnetic stimulation in neuropathic pain. Disabil. Rehabil. 2016; 39: 1–11.
  24. Lefaucheur J.P., Drouot X., Menard-Lefaucheur I. Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J. Neurol. Neurosurg. Psychiatry. 2004; 75: 612–616.
  25. Бородулина И.В., Бадалов Н.Г., Мухина А.А., Гуща А.О. Гидрогальванические ванны как метод медицинской реабилитации: обзор литературы и перспективы клинического применения. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2018; 95: 46–52.
  26. Anderson K.D. Targeting recovery: priorities of the spinal cord-injured population. J. Neurotrauma. 2004; 21 (10): 1371–1383.
  27. Burki J.R., Omar I., Shah P.J., Hamid R. Long-term urological management in spinal injury units in the U.K. and Eire: a follow-up study. Spinal Cord. 2014; 52 (8): 640–645.
  28. Madersbacher H. Diagnosis of functional neurogenic urination disorders from the urologist's viewpoint. Gynakol Rundsch. 1980; 20 (suppl. 2): 161–172.
  29. Ahn U.M., Ahn N.U., Buchowski J.M. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine. 2000; 25 (12): 1515–1522.
  30. Di Benedetto P. Clean intermittent self-catheterization in neuro-urology. Eur. J. Phys. Rehabil. Med. 2011; 47 (4): 651–659.
  31. Vignes J.R., Seze M.D., Dobremez E. Sacral Neuromodulation in Lower Urinary Tract Dysfunction. Advances and Technical Standards in Neurosurgery. 2005; 30: 177–224.
  32. Wong J.J., Côté P., Sutton D.A., Randhawa K. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur. J. Pain. 2017; 21 (2): 201–216.
  33. 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. 2005; 86 (5): 865–870.