Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

•Residual functional complaints are common after first-time lumbar microdiscectomy.•Early physiotherapy after surgery facilitated lumbosacral proprioceptive use.•Early physiotherapy after surgery accelerated sit to stand to sit performance.•Transmuscular (versus paramedian) surgery approach favoured proprioceptive recovery.•Further study in a larger sample size and long-term follow-up is justified.

BackgroundIndividuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy.MethodsPatients were randomly assigned into transmuscular (n = 12) or paramedian lumbar surgery (n = 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n = 12) or usual care (n = 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery.FindingsTwo weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P < 0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P < 0.005), although not seen in the paramedian group and usual care group (P > 0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P < 0.05).InterpretationShortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery.Clinical Trial Number: NCT01505595