The effects of postoperative activity restrictions on outcomes after spine surgery: a systematic review.

Background: Postoperative activity restrictions are commonly prescribed after spine surgery. However, it is unclear whether postoperative restrictions improve clinical or surgical outcomes after spine surgery. The primary aim of this study was to investigate the effects of postoperative activity restrictions in spine surgery on patient-reported outcomes. The secondary aim of the study was to assess whether these postoperative activity restrictions were associated with recurrence (reherniation), adverse events, and complications after spine surgery. Methods: This review included studies discussing degenerative spine surgery patients with postoperative activity restrictions, defined as limitations on specific movements such as bending or twisting, or activities such as driving or weightlifting. Electronic searches were conducted using PubMed, CENTRAL, Embase, and Web of Science databases in November 2024. The Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and Risk Of Bias In Non-randomized Studies - of Interventions, Version 2 (ROBINS-I V2) tools were used to evaluate included studies for risk of bias. Meta-analysis was initially planned but was not performed due to the heterogeneity of the included studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the body of evidence. Results: A total of 3,723 studies were screened. Four studies met the inclusion criteria: one randomized controlled trial and two prospective single-arm cohort studies discussing open lumbar discectomy, and one prospective non-randomized two-group cohort study discussing percutaneous endoscopic lumbar discectomy (PELD). Notably, there are no studies discussing restrictions after cervical or thoracic spinal surgery. Pain, function/disability, and data on recurrence (reherniation), adverse events and complications were collected from each study. The certainty of evidence was low for all outcomes analyzed, making it difficult to provide a definitive conclusion for or against the use of postoperative activity restrictions in spine surgery. Conclusions: Current literature prevents a definitive conclusion regarding the effectiveness of postoperative restrictions in spine surgery. Future studies should address the limitations and heterogeneity of the current literature to provide the basis for standardized, evidence-based postoperative activity restriction protocols.