Rehabilitation with osteopathic manipulative treatment after lumbar disc surgery: A randomised, controlled pilot study

Background: Despite growing evidence regarding the role of osteopathic manipulative treatment (OMT) for the management of low back pain, there is little evidence to support the use of OMT as a post-operative rehabilitation to improve the functional outcomes of lumbar disc surgery. Objective: To assess the feasibility for a future definitive randomised control trial that would indicate whether OMT improves post-operative outcomes after lumbar microdiscectomy compared to a standard exercise programme. Design: Randomised controlled pilot study. Setting: Department of Spinal Surgery and Department of Spinal Rehabilitation at a major metropolitan spine surgery hospital, Seoul, South Korea. Methods: Patients who underwent lumbar microdiscectomy due to low back pain with referred leg pain resulting from a herniated disc were enrolled in the study. Thirty-three patients aged 25-65 years were randomly assigned using a random number table to the OMT (n = 16) group or exercise group (n = 17). Patients received the allocated intervention twice a week for 4 weeks. Each session was 30 min. Primary outcomes were post-surgical functional disability and intensity of low back and leg pain. Outcome measures were assessed at baseline (2-3 weeks after surgery) and post-intervention (7-8 weeks after surgery). Double blinding was not feasible in the study setting. Results: Thirty-three participants were analysed. Both rehabilitation interventions improved all primary and secondary outcomes. Post-surgical physical disability improved more with OMT rehabilitation than the exercise programme (54% vs. 26%, P < 0.05). Residual leg pain decreased with OMT (53%) and exercise (17%). Post-operative low back pain decreased by 37% in the OMT group and 10% in the exercise group. Patients in both groups required less frequent use of medication and were highly satisfied with the rehabilitation interventions. No side effects or complications from any intervention were reported. Conclusion: The current pilot study shows the feasibility of a future definitive randomised control trial investigating whether rehabilitation with OMT is a viable approach for post-operative management of a lumbar microdiscectomy.