Pain, trunk muscle strength, spine mobility and disability following lumbar disc surgery

Objective: To study associations between pain, trunk muscle strength, flexibility and disability in patients with lumbar disc herniation 2 months after surgery. Design: Clinical cross-sectional survey. Participants: 172 operated lumbar disc herniation patients. Methods: Back and leg pain on Visual Analogue Scale, Oswestry Disability Index and Brief Depression Scale were applied to assess the subjectively perceived outcome. Isometric and dynamic strength of trunk muscles and mobility of the lumbar spine were measured to mirror physical impairment. Results: Two months after the operation median leg pain had decreased by 87% and back pain by 81%, respectively. However, moderate or severe leg pain was still reported by 25% and back pain by 20% of the patients. Approximately 30% of the patients perceived moderate or severe disability measured by the Oswestry index. Decreased muscle strength and spine mobility caused functional disability, especially in older patients and patients with postoperative pain. Furthermore, the ratio of trunk extension/flexion strength had changed in favour of the flexion muscles, being 0.98. Greater age and depression were associated with poorer postoperative recovery. Conclusion: Pain, decreased trunk muscle strength and decreased mobility still remained in a considerable proportion of patients with lumbar disc herniation 2 months after surgery. Early identification of those patients with restrictions is essential in order to commence rehabilitation.