Should you have physiotherapy after surgery?

by A Badran At present, surgery is the mainstay of treatment for myelopathy. Whilst it is able to stop further injury to the spinal cord by relieving impingement, the limited capacity for the spinal cord to repair leads to only partial recovery. Therefore strategies to improve recovery after surgery are a major unmet need in myelopathy. This has generated much interest in postoperative therapies to maximise posto [...]

by A Badran

At present, surgery is the mainstay of treatment for myelopathy. Whilst it is able to stop further injury to the spinal cord by relieving impingement, the limited capacity for the spinal cord to repair leads to only partial recovery. Therefore strategies to improve recovery after surgery are a major unmet need in myelopathy.

This has generated much interest in postoperative therapies to maximise postoperative recovery, including the development of neural repair medicines. Unfortunately, whilst showing early promise, these are not yet ready for every-day use.

Physiotherapy on the hand, is routinely employed for many related health conditions, and is considered to significantly contribute to recovery after conditions such as Stroke and Spinal Cord Injury.

Our ambition therefore was to look at the medical literature to see if there was any suggestion it could be of benefit to patients with myelopathy.

How did we go about this?

We performed something called a systematic review and this has recently been published in the journal of Clinical Rehabilitation. (1) This is a research technique which rigorously screens databases of medical literatures. Typically this is done in three stages: Firstly, a search strategy (string of relevant words) is put together. This is then applied to medical literature databases and the results of the search are manually screened, initially by their title and summaries. Any articles considered potentially relevant and then read in full to evaluate their relevance to the research question.

What did we find?

We found only one study commenting on the effects of physiotherapy after surgery for DCM. This is a small retrospective study of 21 patients with DCM that underwent surgery and then rehabilitation. However it was a poor quality study, and spontaneous recovery after surgery could not be distinguished from the effects of physiotherapy specifically. Although the study concluded that rehabilitation improved functional status, the small study size and its design make this conclusions very tentative.

Therefore, unfortunately, we identified that the effect of postoperative physiotherapy in DCM has been poorly studied and we could not make any recommendations about whether it should be routinely provided. This does not mean that physiotherapy is harmful or should not be provided after surgery for degenerative cervical myelopathy but simply more investigation is required.

Pleasingly there are now two registered randomised controlled trials, one in Taiwan and another in Canada, which will hopefully shed light on the effects of postoperative rehabilitation in DCM.

References

1. Badran et al. Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review. Clinical Rehabilitation. April 2018.