Lumbar microdiscectomy and post-operative activity restrictions

Lumbar discectomy is the most commonly performed spine surgical procedure. Lumbar discectomy is performed to treat radicular pain (pain radiating along the distribution of a nerve) unresponsive to conservative management, neurological deficit or less commonly cauda equina syndrome. Lumbar discectomy has evolved to a relatively minimally invasive surgical procedure performed as a day procedure in many centres in North America. Traditionally surgeons have advised patients to restrict post-operative activity due to the hypothesis that this may reduce the risk of disc reherniation and progressive instability at the operated level. In contemporary practice many surgeons do not advise any post-operative activity restriction. Observational studies conducted to date investigating the effect of removal of activity restrictions demonstrated similar outcomes to those reported in the literature for traditional post-operative care. No randomized controlled trial has been performed to investigate this question. The purpose of this study is to directly compare in a randomized controlled trial patients following post-operative activity restrictions and those without post-operative activity restrictions for a period of one month following lumbar microdiscectomy. Patients will undergo standard lumbar microdiscectomy and then be randomized into either the treatment (no restrictions) or control (restrictions groups). For a period of one month following their procedure patients will wear an electronic monitoring device that will record activity and posture. Patients will complete surveys pre-operatively and post-operatively at day one, one month, three months and six months. Patients will also undergo clinical review at one month following their operation. The primary endpoint is a composite endpoint of change in visual analogue scale for pain (for back and legs), Oswestry Disability Index, absence of disc herniation recurrence or reintervention at six months. Additional secondary endpoints will also be assessed.