Article

There are no comparative randomised controlled trials of physiotherapy modalities
for chronic low back and radicular pain associated with multilevel fusion.
Physiotherapy-based rehabilitation to control pain and improve activation levels
for persistent pain following multilevel fusion can be challenging. This is a case report of a 68-year-old man who was referred for physiotherapy intervention
10 months after a multilevel spinal fusion for spinal stenosis. He reported high
levels of persistent postoperative pain with minimal activity as a consequence of
his pain following the surgery.
The physiotherapy interventions consisted of
three phases of rehabilitation starting with pool exercise that progressed to
land-based walking. These were all combined with transcutaneous electrical nerve
stimulation (TENS) that was used consistently for up to 8 hours per day. As
outcome measures, daily pain levels and walking distances were charted once the
pool programme was completed (in the third phase). Phase progression was
determined by shuttle test results. The pain level was correlated with the
distance walked using linear regression over a 5-day average. Over a 5-day moving
average, the pain level reduced and walking distance increased. The chart of
recorded pain level and walking distance showed a trend toward decreased pain
with the increased distance walked. In a patient undergoing multilevel lumbar
fusion, the combined use of TENS and a progressive walking programme (from pool
to land) reduced pain and increased walking distance. This improvement was
despite poor medication compliance and a reported high level of postsurgical pain.

Langue : ANGLAIS