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SPINE Volume 25, Number 12, pp 1523–1532
©2000, Lippincott Williams & Wilkins, Inc.

Can Exercise Therapy Improve the Outcome
of Microdiscectomy?
Patricia Dolan, PhD,* Keith Greenfield, MCSP,† Richard J. Nelson, FRCS,† and
Ian W. Nelson, FRCS‡

Study Design. A prospective randomized controlled
trial of exercise therapy in patients who underwent microdiscectomy for prolapsed lumbarintervertebral disc.
Results of a pilot study are presented.
Objective. To determine the effects of a postoperative
exercise program on pain, disability, psychological status, and spinal function.
Summary of Background Data. Microdiscectomy is often used successfully to treat prolapsed lumbar intervertebral disc. However, some patients do not have a good
outcome and many continue to have low backpain. The
reasons for this are unclear but impairment of back muscle function due to months of inactivity before surgery
may be a contributing factor. A postoperative exercise
program may improve outcome in such patients.
Methods. Twenty patients who underwent lumbar microdiscectomy were randomized into EXERCISE and
CONTROL groups. After surgery, all patients received
normal postoperative carethat included advice from a
physiotherapist about exercise and a return to normal
activities. Six weeks after surgery, patients in the EXERCISE group undertook a 4-week exercise program that
concentrated on improving strength and endurance of the
back and abdominal muscles and mobility of the spine
and hips. Assessments of spinal function were performed
in all patients during the weekbefore surgery and at 6, 10,
26, and 52 weeks after. The assessment included measures of posture, hip and lumbar mobility, back muscle
endurance capacity and electromyographic measures of
back muscle fatigue. On each occasion, patients completed questionnaires inquiring about pain, disability and
psychological status.
Results. Surgery improved pain, disability, back muscle endurance capacity andhip and lumbar mobility in
both groups of patients. After the exercise program, the
EXERCISE group showed further improvements in these
measures and also in electromyographic measures of
back muscle fatigability. All these improvements were
maintained 12 months after surgery. The only further
improvement showed by the CONTROL group between 6
and 52 weeks was an increase in back muscleendurance
capacity.
Conclusion. A 4-week postoperative exercise program
can improve pain, disability, and spinal function in

From the *Department of Anatomy, University of Bristol; and Departments of †Neurosurgery and ‡Orthopaedic Surgery, Frenchay Hospital, Bristol, United Kingdom.
Patricia Dolan is a Research Fellow of the Arthritis Research Campaign, United Kingdom, who provided funding forthis work.
Acknowledgment date: August 27, 1999.
Acceptance date: January 24, 2000.
Device status category: 1.
Conflict of interest category: 14.

patients who undergo microdiscectomy. [Key words:
electromyogram median frequency, exercise therapy, intervertebral disc prolapse, microdiscectomy, randomized
controlled trial, spinal function. Spine 2000;25:1523–1532

Microdiscectomy is oftenused in the treatment of prolapsed intervertebral disc to relieve the associated leg
pain. Its success rate compares favorably with that of
other surgical techniques.5,44,45 However, between 5%
and 20% of patients do not have a satisfactory shortterm outcome,5,17,27,32 and many in whom surgery is
deemed successful continue to have some degree of low
back pain. This may explain why a recentreview of
3,544 patients who had undergone lumbar disc surgery
found that only 70% were fit to resume work within 12
months of operation.14 The costs of such unsatisfactory
outcomes are substantial, both to the patient in terms of
quality of life and lost income and to employers, insurers,
and health service providers in terms of the financial
costs of work loss and subsequent treatment. In the...