Long-Term Refined Paraspinal Muscle Exercises Combined with ERAS Protocol Enhance Postoperative Recovery Following...

This study assesses the impact of long-term refined paraspinal muscle exercises on clinical outcomes in patients undergoing posterior lumbar interbody fusion (PLIF) surgery. We hypothesize that the integration of long-term refined paraspinal muscle exercises with ERAS short-term rehabilitation will result in superior musculoskeletal and psychological recovery compared to ERAS short-term exercises alone.

A total of 298 patients who underwent PLIF surgery between January 2020 and September 2023 were included. Of these, 198 patients (118 males, 80 females) followed the ERAS protocol for short-term recovery, with early mobilization and basic exercises starting within 24 hours post-surgery (ERAS-ST Group). The remaining 100 patients (55 males, 45 females) adhered to ERAS combined with long-term refined paraspinal muscle exercises, beginning within the first week post-surgery and continuing for at least 12 months (ERAS-LT Group). These exercises aimed to strengthen the lumbar and paraspinal muscles, promote long-term functional recovery, and prevent muscle atrophy and related complications. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, the Oswestry Disability Index (ODI) for functional recovery, and PHQ-9 and GAD-7 to measure depression and anxiety symptoms. Muscle strength was evaluated using hand-held dynamometry (HHD), with measurements taken at baseline, 3 months, 6 months, and 12 months post-surgery.

The ERAS-LT group showed significantly better outcomes in pain reduction (VAS), functional recovery (ODI), and psychological well-being (lower PHQ-9 and GAD-7 scores) compared to the ERAS-ST group. Notably, patients in the ERAS-LT Group demonstrated faster recovery in both physical and psychological domains. Key paraspinal muscles showed significantly improved muscle strength in the ERAS-LT Group.

Combining ERAS short-term functional exercises with long-term refined paraspinal muscle exercises significantly improves postoperative recovery in PLIF patients. The long-term exercise regimen enhanced pain management, functional recovery, muscle strength, and psychological well-being, supporting its incorporation into clinical rehabilitation protocols.