Three-stage medical rehabilitation program after decompression surgery on the lumbosacral spine: a comparative controlled study

Introduction Introduction Lumbar intervertebral disc herniation is one of the leading causes of chronic low back pain, functional disability, and reduced quality of life among working-age individuals. Although decompression surgery effectively relieves neural compression, many patients continue to experience persistent pain, impaired neuromuscular control, postural instability, and functional limitations after it. These postoperative impairments highlight the need for evidence-based rehabilitation strategies aimed at comprehensive functional recovery.The aim of this study was to substantiate and evaluate the clinical effectiveness of a three-stage medical rehabilitation program for patients following lumbar decompression surgery based on the principles of Mechanical Diagnosis and Therapy (MDT), incorporating neurodynamic mobilization, core stabilization exercises, and a structured patient education component. Materials and Methods A prospective controlled study included 187 patients who underwent decompression surgery for lumbar intervertebral disc herniation. Participants were allocated into three groups: the intervention group ( n = 63), who underwent a three-stage medical rehabilitation program; a comparison group ( n = 62), who followed a traditional medical rehabilitation program; and a control group ( n = 62), who received basic postoperative physiotherapy and balneotherapy. Treatment efficacy was assessed before the start of rehabilitation, upon its completion, and six months later based on pain intensity, the Oswestry Disability Index, the Schober test, the "Well-being–Activity–Mood" (WAM) test, and stabilometry and electromyography parameters. Results Six months after rehabilitation, patients in the intervention group demonstrated significantly better outcomes than those in the comparison and control groups. VAS pain intensity decreased by 66.0 % (from 5.3 ± 1.2 to 1.8 ± 0.8 points), ODI improved from 46.3 % to 18.9 %, and lumbar mobility assessed by the Schober test reached normal values (6.1 ± 0.6 cm). WAM test scores exceeded the reference norm immediately after the rehabilitation course and maintained a positive trend at the six-month follow-up, whereas no significant normalization was observed in the control group ( p < 0.05). Normalization of postural stability, as assessed by stabilometry, was recorded in 51.7 % of patients in the intervention group, compared to 20.7 % and 17.2 % in the comparison and control groups, respectively ( p < 0.05). Electroneuromyography revealed the most pronounced recovery of neuromuscular function in the intervention group, accompanied by increased M-wave amplitudes — predominantly in the m. rectus femoris (+36.0 %) and m. gastrocnemius (+34.8 %) — whereas significant improvement in the control group was observed only for the m. tibialis anterior . All intergroup differences were statistically significant ( p < 0.05). Discussion The combination of Mechanical Diagnosis and Therapy, stabilization exercises, neurodynamic mobilization, and structured patient education provided more effective restoration of neuromuscular control, spinal function, and postural stability than conventional rehabilitation. The program effectively addressed both mechanical and functional impairments, resulting in greater pain reduction and improved recovery of daily activities. Conclusion The three-stage rehabilitation program proposed is an effective and clinically justified approach for patients undergoing lumbar decompression surgery. Compared with standard rehabilitation, it provides superior pain relief, functional recovery, restoration of neuromuscular function, and postural stability, supporting its implementation in routine postoperative rehabilitation practice.

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