Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (9): 1398-1403.doi: 10.3969/j.issn.2095-4344.4008

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A prospective study on the application of staged lumbar motion chain rehabilitation based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy

Lü Zhen1, 2, 3, Bai Jinzhu1, 2, 3   

  1. 1Department of Spinal Surgery, Beijing Bo’ai Hospital of China Rehabilitation Research Center, Beijing 100068, China; 2School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; 3Department of Orthopedics, Capital Medical University, Beijing 100070, China
  • Received:2020-05-23 Revised:2020-05-27 Accepted:2020-06-19 Online:2021-03-28 Published:2020-12-15
  • Contact: Bai Jinzhu, Chief physician, Department of Spinal Surgery, Beijing Bo'ai Hospital of China Rehabilitation Research Center, Beijing 100068, China; School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; Department of Orthopedics, Capital Medical University, Beijing 100070, China
  • About author:Lü Zhen, MD, Attending physician, Department of Spinal Surgery, Beijing Bo'ai Hospital of China Rehabilitation Research Center, Beijing 100068, China; School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; Department of Orthopedics, Capital Medical University, Beijing 100070, China
  • Supported by:
    the Scientific Research Project of Health System in Fengtai District of Beijing, No. 2019-117

Abstract: BACKGROUND: Lumbar percutaneous transforaminal endoscopic discectomy can decompress nerve root compression caused by herniated lumbar disc. Postoperative rehabilitation not only includes the recovery of surgical trauma, but also the recovery of lumbar muscle damage accompanied by lumbar disc herniation and the recovery of pelvic-leg function imbalance. 
OBJECTIVE: To evaluate the effectiveness and feasibility of staged rehabilitation program of lumbar motor chain based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy.
METHODS: Totally sixty-two patients with lumbar disc herniation who were treated in the Beijing Bo’ai Hospital of China Rehabilitation Research Center from January 2012 to December 2018 underwent percutaneous transforaminal endoscopic discectomy. The patients were randomly divided into experimental group and control group, 31 cases in each group. The experimental group performed remote staged rehabilitation guidance based on McKenzie’s technology according to pre-set rehabilitation program for postoperative rehabilitation of lumbar motion chain: 2-6 weeks after operation as the first stage, 7-12 weeks as the second stage and 13-24 weeks as the third stage. Control group received regular postoperative rehabilitation. Visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were assessed in both groups pre-rehabilitation and 6, 12, and 24 weeks post-rehabilitation. Cross sectional area of the multifidus of the lumbar spine was detected under MRI 12 weeks post-rehabilitation. Gait analysis was conducted 24 weeks post-rehabilitation by using three-dimensional motion acquisition and analysis system. This study was approved by the Ethics Committee of Beijing Bo’ai Hospital of China Rehabilitation Research Center (approval No. 2019-011-1). 
RESULTS AND CONCLUSION: (1) After rehabilitation, visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were improved to different degrees in both groups compared with those before rehabilitation. Visual analogue scale score and Oswestry Disability Index were lower in the experimental group than those in the control group at 6 and 12 weeks (P < 0.05). Japanese Orthopaedic Association score was higher in the experimental group than in the control group at 6 weeks (P < 0.05). At 6, 12, and 24 weeks, SF-36 score was higher in the experimental group than that in the control group (P < 0.05). (2) No significant difference in cross sectional area of the multifidus of the lumbar spine was found between the two groups (P > 0.05). (3) Gait analysis exhibited that the ratio of left to right in the supporting phase of the experimental group was higher than that of the control group at 24 weeks         (P < 0.05). (4) Results suggest that the staged rehabilitation program after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation is in line with the characteristics of postoperative recovery of lumbar disc herniation, and has good effectiveness and feasibility.

Key words: bone, percutaneous transforaminal endoscopic discectomy, lumbar disc herniation, rehabilitation, multifidus muscle, gait abnormality, pelvic function, low back pain, McKenzie’s technique

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