Usefulness of a cognitive behavioural and rehabilitative approach to enhance long lasting benefit after lumbar spinal stenosis and degenerative spondylolisthesis surgery

Most spine-surgically treated patients are considered eligible for rehabilitative treatment. Unfortunately, an evidence-based consensus on the best postsurgical conservative treatment is not mentioned. In absence of a shared pathway, physical therapies, exercises, back schools, massages and other manual therapies are sometimes recommended by surgeons and clinicians. Like common low back pain, spinal problems in the postsurgical phase should be reconsidered through a bio-psycho-social model, advocating comprehensive evaluations and broader answers to patient-perceived pain, disability, and quality of life needs. The Authors report the clinical case of a 60-year-old woman, operated for lumbar spinal stenosis (LSS) and L4-L5 degenerative spondylolisthesis, early entered in a Rehabilitation Hospital Unit, undergoing rehabilitative and cognitive behavioural therapy. Physical and psychological evaluation, outcome measures, physical and psychological therapies are here illustrated. The obtained results are encouraging for pain, disability and quality of life, assessing usefulness of a bio-psycho-social approach for spine-operated patients. A randomized controlled trial for rehabilitative and cognitive behavioural postsurgical treatment for patients with lumbar spinal stenosis and degenerative spondylolisthesis is advocated to provide further evidence to approaches and results. Proper outcome measures, correct clinical relevance evaluation and adequate follow-ups are needed.