19.1. Principles and Individual Rehabilitation Planning
@ProfFishchenkoRehabilitation after endoscopic spine surgery aims to restore daily activity, muscle strength, endurance, and motor skills. We develop the program according to the procedure performed, the postoperative course, and the patient's functional limitations.
After prolonged neural compression, weakness of individual muscle groups, gait disturbances, and reduced exercise tolerance may persist. These are often accompanied by the consequences of prolonged inactivity. These impairments define the main rehabilitation goals.
1. Planning the rehabilitation program
Before sessions begin, the rehabilitation specialist must receive information about the level and extent of surgery, the presence of stabilizing instrumentation, residual neurological deficits, and features of the postoperative course.
The surgeon determines restrictions related to the procedure performed and tissue healing. The rehabilitation specialist assesses the patient's movement abilities, selects exercises, and prescribes their dosage. At repeat consultations, the program is adjusted according to the results achieved.
Comorbidities, preoperative physical activity, occupational demands, and conditions at home are considered separately. A patient with longstanding walking limitations and a patient who exercised regularly before surgery need different initial workloads.
This approach to exercise prescription is described in the review by Haddas et al.: the authors identify the nature of surgery, previous functional level, comorbidities, and tissue healing times among the main factors. Haddas et al., 2025.
2. Functional assessment and recovery goals
The initial assessment covers self-care, walking, stair use, tolerance of sitting and standing, and the need for assistance. Strength, endurance, balance, and coordination are assessed during achievable movement tasks.
The activities that remain difficult are identified. For one patient, the immediate goal may be independent mobility outside the apartment; for another, return to computer-based or physical work. Exercises and the sequence of progression are selected accordingly.
Goals are formulated specifically: increase walking distance, reduce the need for support, restore confident stair use, or improve tolerance of occupational demands. At reassessment, performance of these same tasks is compared.
The movements the patient avoids and the reasons for their concerns are also identified. Explaining the technique and performing the exercise with the specialist helps prepare the patient for independent sessions.
3. Exercise selection and dosage
The program includes exercises to restore specific movement functions. Depending on the patient's needs, work focuses on muscle strength and endurance, balance, coordination, mobility, and overall physical capacity. Part of each session is devoted to movements needed in daily life.
For each exercise, the starting position, range, pace, number of repetitions, holding time, and rest are specified. The specialist demonstrates the exercise, checks performance, and simplifies the task if needed.
Total activity during the day is considered. Travel to the session, a long walk, household tasks, or return to work may substantially alter tolerance of the usual exercise program.
Exercises that the patient has already learned to perform are selected for the home program. Written recommendations specify their dosage and sequence. Videos are used to review the technique.
Our rehabilitation materials provide exercise programs for different procedures and stages of recovery. The specialist selects exercises from them according to the patient's condition.
4. Adjusting the workload
At repeat sessions, technique, tolerance of the current program, and its effect on daily activity are assessed. The patient is asked how they feel during exercise, after the session, and the next day.
The workload is increased gradually by changing repetitions, duration, resistance, or movement complexity. The extent of progression depends on the type of surgery, current restrictions, and the patient's response.
An increase in symptoms after a session requires review of the exercises and their dosage. Other activity during the day is also assessed. If a new or increasing neurological deficit develops, sessions are stopped and a medical examination is performed.
Studies after lumbar fusion have used different rehabilitation start times and programs. Oestergaard et al. compared the start of the same group program at 6 and 12 weeks after surgery in 82 patients. At one year, the reduction in disability measured by ODI was greater in the group starting sessions at 12 weeks. Oestergaard et al., 2012.
Kernc et al. studied a trunk muscle activation and strengthening program begun 3 weeks after fusion. The study included 27 patients. At 3 months, the training group had better trunk muscle strength and walking speed; the advantage was not maintained at 18 months. Kernc et al., 2018.
5. Organization of sessions
Home sessions are combined with consultations to check technique and adjust the program. Consultation frequency is determined according to the need for assistance and the course of recovery.
Patients with balance disturbances, marked muscle weakness, or difficulty performing exercises require more supervised sessions. As the program is learned, the proportion of independent work may increase.
In the systematic review by Manni et al., supervised sessions after disc herniation surgery provided greater reductions in pain and disability than independent exercises or recommendations in some comparisons. The authors rated the evidence quality as low or very low. Manni et al., 2023.
In the randomized study by Oosterhuis et al., referral to a 6–8-week exercise program immediately after discharge following discectomy did not improve pain, function, or overall recovery compared with no such referral during 26 weeks of follow-up. Oosterhuis et al., 2017.
The current rehabilitation plan is recorded in the recommendations: functional goals, the exercise list, dosage, restrictions, and the reassessment date.
References
1. Haddas R., Remis A., Barzilay Y. et al. Therapeutic exercise following lumbar spine surgery: a narrative review. North American Spine Society Journal. 2025;23:100620. DOI: 10.1016/j.xnsj.2025.100620.
2. Manni T., Ferri N., Vanti C. et al. Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis. Archives of Physiotherapy. 2023;13:21. DOI: 10.1186/s40945-023-00175-4.
3. Oosterhuis T., Ostelo R.W., van Dongen J.M. et al. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy. 2017;63(3):144–153. DOI: 10.1016/j.jphys.2017.05.016.
4. Oestergaard L.G., Nielsen C.V., Bünger C.E. et al. The effect of early initiation of rehabilitation after lumbar spinal fusion: a randomized clinical study. Spine. 2012;37(21):1803–1809. DOI: 10.1097/BRS.0b013e31825a17ab.
5. Kernc D., Strojnik V., Vengust R. Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2018;13:151. DOI: 10.1186/s13018-018-0853-7.
Next subsection: 19.2. Rehabilitation After Endoscopic Lumbar Discectomy