Rehabilitation Following Lumbar Total Disc Replacement, With a Focus on Lumbar Multifidus Morphology and Function: A Case Report and Review of the Literature

Abstract

Background Lumbar total disc replacement (TDR) is an option for patients with severe low back pain from degenerative disc disease who have failed conservative treatment. Paraspinal muscles have played an important role in clinical outcomes after lumbar surgery. The purpose of this study was to investigate lumbar multifidus morphology and function in a patient following lumbar TDR and a postoperative rehabilitation exercise program. Case Presentation A 52-year-old man underwent TDR surgery at the L5-S1 level to treat his chronic low back pain, which had been present for several years and unresponsive to previous conservative management. Six weeks after the operation, the patient initiated an 8-week postoperative rehabilitation program focusing on motor control and strengthening exercises. Outcome and Follow-Up The patient experienced clinically important improvements in pain and disability, as well as improvements in lumbar multifidus size ranging from 3.17% to 13.84% and changes in thickness contraction ranging from 4.04% to 16.48%, following the postoperative rehabilitation program. However, differences in lumbar multifidus muscle morphology and function were observed when comparing the surgical site to the superior motion segment. Discussion This case report displays limited evidence regarding the effects and implementation of a motor control and strengthening exercise program following lumbar TDR. Some improvements in muscle morphology and function were observed, along with improvements in pain and disability, after the completion of the exercise program. The importance of including lumbar multifidus morphology and function in the postoperative rehabilitation of this population may warrant further research. JOSPT Cases 2022;2(1):34–41. doi:10.2519/josptcases.2022.10163