Structured Inpatient Rehabilitation After Endoscopic Lumbar Discectomy: Effects on Early and Long term Recovery

Objective: Postoperative rehabilitation after endoscopic lumbar discectomy (ELD) remains heterogeneous, and evidence supporting structured inpatient rehabilitation programs is limited. Whether a short, standardized inpatient program can accelerate postoperative recovery without increasing the risk of recurrence remains uncertain. To evaluate whether a 2-week structured inpatient rehabilitation program initiated 4 weeks after ELD improves early postoperative outcomes compared with usual postoperative care.Methods: This retrospective controlled cohort study included 102 consecutive patients who underwent single-level ELD at L4–5 or L5–S1. Allocation to the rehabilitation group (n=49) or control group (n=53) was determined by inpatient bed availability and patient preference, without clinical or radiological allocation criteria. The primary outcome was the Oswestry Disability Index (ODI) assessed at 6 weeks and 12 months postoperatively. Secondary outcomes included back and leg pain measured by the visual analogue scale (VAS), achievement of the minimal clinically important difference (MCID; ODI improvement ≥10 points), complications, and recurrence. Analyses included analysis of covariance adjusted for operated level, as well as subgroup analyses stratified by level.Results: Baseline characteristics were comparable between groups, except for operated level (p=0.004). At 6 weeks, the rehabilitation group demonstrated significantly greater improvement in ODI (adjusted mean difference, -5.8; 95% confidence interval, -9.2 to -2.4; p=0.002) and VAS pain scores (p0.05). Recurrence rates were comparable between groups (8% vs. 5.7%, p=0.62), and no recurrence occurred during the inpatient rehabilitation period. Three recurrent cases underwent endoscopic revision surgery, whereas the remaining cases were managed conservatively with good clinical response.Conclusion: A short, structured inpatient rehabilitation program after ELD accelerates early functional recovery and pain improvement without increasing complications or recurrence. Long-term outcomes remain comparable between groups, indicating that the benefits of structured rehabilitation are predominantly early and functional. Standardized rehabilitation pathways may therefore enhance early postoperative recovery following minimally invasive lumbar discectomy.