Research Summary

Liberal Ambulation After Lumbar Fusion Linked to Shorter Stays, Fewer Complications

Kate Young

Key Highlights

  • Liberal ambulation protocols after lumbar fusion were associated with shorter hospital stays and fewer complications.
  • Restricted ambulation protocols were linked to higher complication rates and reduced likelihood of discharge to home.
  • Early mobility, particularly greater gait distance in the first inpatient physical therapy session, predicted improved outcomes.

In a retrospective study conducted by Rajkishen Narayanan, MD, and colleagues, liberal ambulation protocols following lumbar fusion were associated with significantly better outcomes, including shorter length of stay, fewer complications, reduced reoperation rates, and greater likelihood of discharge home, compared with restricted ambulation approaches.

Early ambulation has been recognized as a critical component of recovery after surgery. Despite this, some hospitals adopt conservative ambulation practices because of concerns regarding patient safety. This study was conducted to provide comparative evidence on the impact of liberal versus restricted ambulation protocols in the context of posterior lumbar decompression and fusion surgery.

Researchers performed a retrospective cohort study of adult patients (≥18 years) undergoing primary posterior lumbar decompression and fusion between 2021 and 2022 within a single health system. Patients treated at hospitals using restricted versus liberal ambulation protocols were matched by demographic characteristics. Outcomes assessed included inpatient complications, length of stay, readmissions, reoperations, discharge disposition, and mobility measures such as AM-PAC daily activity scores, pain ratings after therapy, and gait trial distance at the first physical therapy session.

Patients treated with liberal ambulation protocols demonstrated shorter hospital stays (P < .001) and reduced reoperation rates within 1 year (P = .013). In contrast, those under restricted ambulation were more likely to experience complications (P = .005) and were less often discharged home (P = .020). Liberal ambulation also correlated with higher AM-PAC mobility scores and longer gait distances (both P < .001). On multivariable regression analysis, greater gait distance at the first inpatient therapy session predicted fewer complications (P = .010), decreased length of stay (P = .005), and increased likelihood of home discharge (P < .001).

“Liberal ambulation protocols are safe and effective postoperative management strategies after PLDF to decrease inpatient complications, length of stay and discharge to a rehabilitation facility,” Narayanan and colleagues concluded. “These findings highlight the role that such protocols can play in helping patients to achieve early mobilization and favorable short-term outcomes.”

Reference:
Narayanan R, Kellish A, Ezeonu T, et al. Comparison of restricted versus liberal postsurgical ambulation protocols on outcomes after lumbar fusion surgery. Spine (Phila Pa 1976). 2025;50(12):809-815. doi:10.1097/BRS.0000000000005118