Outcomes of Posterior Instrumented Lumbar Fusion With or Without Physiotherapy: A Narrative Review
Asim Aziz1, Muhammad Umer Khan2, Farwa Saleem3, Aashir Riaz1, Sajjad Hussain1, Saoud Javed1*, Kainat Bibi1
1Dr. Ziauddin Hospital, Karachi, Pakistan.
2RIMS Trauma Hospital, Pakistan.
3Quaid-e-Azam Medical College, Bahawalpur, Pakistan.
*Corresponding Author: Saoud Javed, Dr. Ziauddin Hospital, Karachi, Pakistan.
https://doi.org/10.58624/SVOAOR.2026.06.015
Received: June 07, 2026
Published: July 03, 2026
Citation: Aziz A, Khan MU, Saleem F, Riaz A, Hussain S, Javed S, Bibi K. Outcomes of Posterior Instrumented Lumbar Fusion With or Without Physiotherapy: A Narrative Review. SVOA Orthopaedics 2026, 6:4, 103-110. doi: 10.58624/SVOAOR.2026.06.015
Abstract
Posterior instrumented lumbar fusion (PILF) is a widely performed surgical intervention for treating degenerative lumbar disorders. Although modern instrumentation achieves high fusion rates, many patients experience residual pain and disability. Physiotherapy is often prescribed to optimize recovery; however, its effectiveness, timing, and format remain debatable. A narrative review was conducted by searching PubMed and Embase (2019–2025) for systematic reviews, randomized controlled trials, and meta-analyses reporting the outcomes of PILF with or without rehabilitation. The outcomes included pain, disability, quality of life, fear-avoidance, return to work, and fusion success. Structured physiotherapy programs, especially multimodal interventions combining exercise and cognitive-behavioral strategies, were associated with improved pain, disability, and psychosocial recovery compared with the usual care. Early initiation of physiotherapy within one month was safe and accelerated short-term outcomes, although long-term differences diminished after one year. Posterior instrumentation consistently achieves high fusion rates and favorable surgical outcomes; however, evidence on whether rehabilitation influences structural outcomes, such as hardware survival or adjacent segment degeneration, is limited. Physiotherapy provides meaningful additive benefits after PILF, particularly in the first 6 months. Therefore, incorporating structured rehabilitation into postoperative care is recommended. Future trials should standardize protocols, assess cost-effectiveness, and explore long-term outcomes.
Keywords: Cognitive-behavioral therapy, Degenerative spinal disorders, Enhanced Recovery After Surgery, Rehabilitation, Return to work