Postoperative recommendations for single-level lumbar disc herniation: a cross-section survey

Lumbar degenerative disc disease is one of the leading causes of low back and leg pain. Conservative treatment is the mainstay treatment, but for some patients surgical approach is required. The literature concerning postoperative recommendations on patients' return to work is sparse. The aim of this study is to assess spine surgeons' consensus regarding postoperative recommendations, including return to work, restart of daily-living activities, analgesic medication usage and rehabilitation referral.

An online GoogleForms survey was sent, via electronic mail, during January 2022, to 243 surgeons described as having expertise in spine surgery, using the dissemination means of Sociedade Portuguesa de Patologia da Coluna Vertebral and Sociedade Portuguesa de Neurocirurgia. Participants (n = 59) had predominantly hybrid clinical practice in Neurosurgery field.

Only in a minority of cases (1.7%) no recommendation was given to patients. Nearly 68% of participants advised patients to return to sedentary professional work up until the 4^th postoperative week. Light and heavy workload workers were advised to wait longer until initiating work activity. Low mechanical impact activities are started up to 4 weeks, and higher stress activities should be further postponed. Half of the surveyed surgeons estimates to refer to rehabilitation 10% or more patients. No differences were found when comparing recommendations given by more and less experienced surgeons-as defined by number of years in practice and number of annual surgeries-for most activities.

Despite not having clear guidelines in postoperative management of surgically treated patients, Portuguese practice is in line with international experience and literature.