The effect of physical therapy in spine surgery: a systematic review.

Abstract

While physical therapy is a well-established preoperative intervention to manage pain and improve function for patients undergoing spinal surgery, its postoperative utility, particularly following fusion procedures, remains less well defined. We aim to systematically review the current literature on the efficacy of physical therapy following spine surgery. A systematic review in accordance with PRISMA guidelines was performed with a comprehensive search in PubMed, EBSCO, and CINAHL database. The database was searched up to March 2025 with the following MESH terms using AND or OR boolean operators: ("Spine/surgery" "Spinal Fusion" "Laminectomy" "Discectomy"), ("Physical Therapy Modalities" "Exercise Therapy" "Rehabilitation"), and ("Treatment Outcome" "Outcome Assessment (Health Care)" "Recovery of Function"). Thirty-one studies involving 4,335 patients were included: 22 RCTs, 8 retrospective analyses and 1 prospective cohort. Studies focused on lumbar surgeries (n = 25) and cervical surgeries (n = 6). In lumbar fusion studies (n = 7), 43% (3/7) demonstrated significant pain improvement and 17% (1/6) showed reduced disability with postoperative rehabilitation. Among non-instrumented lumbar procedures (n = 18), 63% (10/16) of studies found greater pain relief and 59% (10/17) observed reduced disability with physical therapy. Cervical studies revealed pain benefits in 40% (2/5) of trials and disability improvement in 33% (1/3) associated with postoperative physical therapy. Evidence supporting postoperative physical therapy following lumbar fusion is mixed with respect to pain, disability, and functional outcomes. In contrast, non-instrumented lumbar procedures show more consistent benefit, particularly in pain outcomes. Additional high-quality randomized controlled trials are warranted to better define the role of rehabilitation in post-operative spinal surgery care.