During these three hours, I planned and conducted an appointment with a client who was nearly two weeks post lumbar spine surgery.

Reflective Summary

The client reported that they had a transforaminal lumbar interbody fusion (TLIF) at L4-L5, L5-S1 and a decompression at L2, L3, L4 and L5. A TLIF approach involves the removal of an intervertebral disc and the joining two or more vertebrae together using a cage and screws to help improve spinal stability (Phan, Thayaparan & Mobbs, 2015). The client has requested to have rehabilitation from Marjon and has discharged himself from Physiotherapy at Derriford. This promoted me to research the contradictions for each stage of recovery for lumbar spine surgery. From my research I found that the common movements to avoid after this type of surgery include excessive bending, twisting and lifting. This corresponded with the clients aftercare advice.

It has been consistently reported in the literature that in the first few months post-operation, the patient will be encouraged to walk and perform light abdominal, back and thigh muscle exercises (Tarnanen et al., 2012). My client is already making excellent progress and has managed to walk just over three miles in less than two weeks after the operation. In the session I also demonstrated and implemented light transverse abdominus and pelvic contraction exercises which included pelvic tilts, heel slides, knee hugs with assistance from a towel and bent knee fall outs, the focus for the client being to engage their core muscles. These types of exercises may be considered in post operation care of the lumbar as there is a consistent idea that the stability and control of the spine are altered in people with lower back pain (LBP) (Shamsi, Sarrafzadeh & Jamshidi, 2015). Similarly Abbott, Tyni-Lenné and Hedlund (2010) study implemented lumbopelvic stabilisation with transverse abdominus and lumbar mulitfudius co contractions while maintaining a neutral spine in supine, sitting and standing. They found that these types of exercises in combination with cognitive behavioural strategies could be implemented as they resulted in a better outcome compared to just exercises therapy after lumbar spine fusion.

I am also going to get the client to complete a questionnaire every two-three weeks so that progress can be seen. The Oswestry Low Back Pain Disability Questionnaire can be used to assess disability due to back pain (Tarnanen et al., 2012).

What Went Well

I conducted a thorough consultation with the client and believe that I asked all the appropriate questions in order to get the relevant information.

Areas for Improvement	Action Plan
Increase my knowledge on the other types of operational procedures.	Research common surgeries at each joint and the possible contraindications for each stage of rehabilitation.
Ensure with every client I have their consent to treat.	Next time ensure that I write down in the notes that they have confirmed consent to treat verbally.

Closing the Loop 

Since writing this reflection I have continued to see the client and have progressed their rehabilitation.

References

Abbott, A. D., Tyni-Lenné, R., & Hedlund, R. (2010). Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Spine, 35(8), 848-857.

Phan, K., Thayaparan, G. K., & Mobbs, R. J. (2015). Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion–systematic review and meta-analysis. British journal of neurosurgery, 29(5), 705-711.

Shamsi, M. B., Sarrafzadeh, J., & Jamshidi, A. (2015). Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiotherapy theory and practice, 31(2), 89-98.

Tarnanen, S., Neva, M. H., Dekker, J., Häkkinen, K., Vihtonen, K., Pekkanen, L., & Häkkinen, A. (2012). Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol. BMC musculoskeletal disorders, 13(1), 1-7.