About Rehabilitation after Lumbar Spine Surgery

Pain and disability caused by lumbar disc herniation, spondylolisthesis, and stenosis are common reasons for lumbar surgery referrals. Lumbar disc herniation with radiculopathy is the most frequent cause for low back surgery in adults under 65. Spondylolisthesis and stenosis account for a significant portion of spinal surgeries as well.

Post-surgical rehabilitation aims to achieve and maintain optimal function, minimize muscle weakness or kinesiophobia, and promote recovery. Individual outcomes depend on health status, the severity of the condition, and the type of surgery performed. Recovery is best supported through a combination of post-surgical rehabilitation strategies aligned with patient goals.

About CCG Care Pathways

Purpose

CCG is a knowledge translation resource of the Canadian Chiropractic Association. Its care pathways help chiropractors and other clinicians organize conservative care for musculoskeletal conditions. Each pathway outlines the main steps of the clinical encounter and supports decisions about assessment, care, monitoring, referral, co-management, and discharge. The pathways provide a structured approach to care, not a fixed prescription.

Development

Pathways draw on relevant clinical practice guidelines, systematic reviews, peer-reviewed literature, and safety or professional sources. These sources inform, but do not determine, pathway content. Their findings reflect the questions, populations, outcomes, methods, and judgments used and may not apply to every person. Condition-specific sources are identified by author or organization and year, with full citations in one reference list at the end of the pathway.

Principles of Care

Musculoskeletal conditions are shaped by physical, psychological, social, cultural, and environmental factors, so no single approach fits everyone. Good care is ethical, evidence-informed, person-centred, culturally responsive, and tailored to the patient’s goals, preferences, circumstances, and response. Shared decision-making and informed consent guide care. Education, active rehabilitation, and self-management support recovery, functioning, participation, and long-term health. Regular reassessment shows whether the plan is helping and when to continue, adapt, stop, refer, co-manage, or discharge.populations.

Pathway Flow at a Glance

The pathway follows a recurring clinical cycle: understand the person and their goals; screen for safety and referral needs; develop a working clinical profile; agree on a plan and relevant outcomes; provide care; reassess response and safety; and continue, adapt, stop, refer, co-manage, or discharge as appropriate.

Disclaimer

CCG care pathways support professional clinical judgment; they do not replace it or the advice of a qualified provider. They are not prescriptive, authoritative, or regulatory and are not intended for diagnosis or billing. Clinicians remain responsible for practicing within their competence and scope, meeting applicable legal and regulatory requirements, obtaining informed consent, recognizing emergencies, and arranging referral or co-management when needed.

Care Pathway for Rehabilitation after Lumbar Spine Surgery

1. Record Keeping

Accurate, timely, and sufficiently detailed documentation supports safe, high-quality care. The record should reflect clinically relevant patient interactions, clinical reasoning, decisions, care provided, and progress over time. Documentation should meet the legal, regulatory, privacy, retention, and organizational requirements that apply where the clinician practices. A structured format, such as SOAP, may support consistency, clarity, and continuity and can be adapted to the encounter and practice setting.

Subjective: Record the patient’s concerns, symptoms, functioning and participation, goals, preferences, relevant history and context, and response or adverse effects from previous care.

Objective: Record relevant examination findings, outcome measures, diagnostic test results when available, and clinically important changes.

Assessment: Record the clinical interpretation of findings, working diagnosis or clinical profile, differential and safety considerations, relevant risk factors or modifiers, and the patient’s progress or response.

Plan: Record care provided or proposed, education and self-management, consent and patient decisions, changes to the plan, agreed outcomes and reassessment point, referrals or co-management, follow-up, and discharge planning.

Document at the time of the encounter or as soon as practicable. Corrections and additions should preserve the integrity of the record. Clear records support patient safety, shared decision-making, communication, continuity, and accountability.

2. Informed Consent

Definition: A continuing process in which a capable patient, or an authorized substitute decision-maker when required, voluntarily agrees to a proposed examination or intervention after receiving and understanding the information needed to make an informed choice.
Key Aspects:
- Prior to interaction: Obtain consent before beginning an examination, procedure, or treatment, except where applicable law permits otherwise. Explain what is proposed and why. Revisit consent when the plan or material information changes.
- Voluntarily and specific: must be voluntary and specific to the proposed care. Consider the patient’s capacity for the decision at the time it is required and follow applicable requirements for substitute decision-making when the patient lacks capacity. The patient may ask questions, refuse, place limits on, or withdraw consent.
- Transparent process: Use honest, plain, and accessible communication. Offer interpretation or other communication support when needed and consider language, culture, health literacy, disability, and prior trauma. Written or digital information may support but does not replace discussion.
- Patient understanding and agreement:
  - Diagnosis/prognosis: Explain relevant findings, the clinical impression or working diagnosis, important uncertainty, and the expected course in understandable language.
  - Treatment plan: Discuss the nature and purpose of proposed care, expected benefits, material risks and side effects, burdens, reasonable alternatives, the option of no intervention, and the likely consequences of accepting or declining.
  - Questions: Invite questions, explore goals and preferences, allow appropriate time for a decision, and confirm understanding, for example using teach-back.
- Documentation: Record the consent discussion and decision, including material information provided, questions, capacity or substitute decision-maker where relevant, consent, refusal, limits or withdrawal, and any need to revisit consent. Follow documentation requirements applicable to the jurisdiction and practice setting.

3. Health History

Apply cultural awareness and trauma-informed care principles.
Sociodemographic information: Age, gender, sex, race/ethnicity.
Main concern: Post-surgical recovery, including functional status, mobility limitations, residual symptoms, and pain management needs.
Surgical history: Reasons for surgery, type of surgery, complications, in-patient rehabilitation experiences.
Body systems: Neurologic, cardiovascular, genitourinary, gastrointestinal, musculoskeletal, bone density, eyes/ears/nose/throat, respiratory, skin, mental health, reproductive.
Health, lifestyle, family, social, and occupational history: Past medical conditions, medications (including opioids), supplements, trauma/injuries, hospitalizations, surgeries, diet, exercise, sleep habits, smoking, alcohol/substance use, family support, caregiver responsibilities, work/school environment.
Social determinants of health: Employment, childcare, education, nutrition, housing, domestic violence, child maltreatment, discrimination, social isolation.
Previous treatments: Document treatments for the pre-surgical condition, including prehabilitation (“pre-hab”) interventions, their effectiveness, and any adverse events.
Beliefs and expectations: Assess patient understanding of their condition, treatment goals, and outcome expectations.
Flag considerations: Identify red, yellow, and orange flags for potential referrals.

Outcomes Assessments: Prioritize approaches that align with the patient’s specific goals and clinical presentation.

Pain: Use pain scales (e.g., NRS) and diagrams.
Function and participation: Evaluate impact of post-surgical pain on daily activities (PSFS, WHODAS, ODI, RMDQ).
Recovery: Self-rated recovery scales.
Quality of life: SF-12.
Sleep quality: PSQI.
Work/school status: Monitor return to activities.
Individual goals: Set SMART goals (Specific, Measurable, Achievable, Relevant, Timely) to guide recovery. Clinicians should help patients establish realistic and reasonable (“R”) goals based on their full clinical presentation and prognosis [see Section 10], ensuring expectations align with likely recovery outcomes.
Patient feedback: Gatherand integrate patient experience and satisfaction.

4. Red Flags : Differential Diagnosis Requiring Medical Referral

ACTION: Refer immediately to emergency care:

Cauda equina syndrome (CES): Severe back pain, saddle anesthesia, bladder/bowel dysfunction, bilateral radicular signs, progressive lower limb weakness, decreased perineal sensation, reduced anal sphincter tone. Note: Despite decompression surgery, CES can still occur postoperatively due to hematoma or excessive scar formation compressing neural structures.
Infection: Redness/swelling/heat near the wound, fever, chills, fatigue, malaise, flu-like symptoms, difficulty breathing, wound discharge with foul odour or red streaks extending from the wound.
Deep vein thrombosis (DVT) / Pulmonary embolism (PE): Pain/redness/warmth/swelling in popliteal region, calf, or groin; difficulty breathing, chest pain, coughing, dizziness (indicative of PE).
Dural tear/cerebrospinal fluid leak: Positional headache, neck pain, nausea/vomiting, cranial nerve signs.
Progressive neurological deficits: Increasing weakness, sensory loss, or worsening radiculopathy—potentially due to post-surgical hematoma, scar formation, hardware migration, or implant malposition.

ACTION: Refer to appropriate medical provider:

Hardware failure/implant migration/spinal fracture: Progressive pain unresponsive to care, new focal radicular deficits, osteoporosis, corticosteroid use, female, older age (>60), or history of spinal fracture/cancer.
Potential complications include hardware breaching the pedicle, impinging the neural foramen, or—though rare—vascular injury (e.g., aortic or iliac vessel puncture). Includes cases of post-surgical spondylolisthesis related to progressive instability or hardware failure.

5. Orange Flags: Symptoms of Psychiatric Disorders Requiring Referral

Orange Flags are signs that a mental health or substance use concern may require emergency or timely assessment or shared care, and may change whether and how MSK care proceeds. They are not diagnoses. Ask directly and respectfully when concern arises, considering immediate safety, severity, change from usual, daily functioning and context. Psychosocial factors that may affect recovery but do not require separate mental health or medical assessment are addressed under Yellow Flags.

ACTION: Arrange emergency assessment now when there is immediate danger or an urgent medical need:

Suicide, self-harm or harm to others: current intent or plan, a recent attempt, inability to stay safe, or behaviour suggesting an immediate risk of serious harm.
Severe change in mental state: extreme agitation, confusion, disorganization, possible psychosis or mania with impaired judgment or unsafe behaviour, or inability to meet basic needs when this creates immediate danger.
Substance-related or medical emergency: suspected overdose, severe intoxication, dangerous withdrawal, delirium or another sudden change requiring urgent medical care.

When immediate safety is uncertain, do not leave the person alone while help is arranged. Follow local emergency procedures and call 9-1-1 for immediate danger or urgent medical need. If the person is thinking about suicide, call or text 9-8-8: Suicide Crisis Helpline with them or support them to do so.

If violence, abuse or exploitation is disclosed or suspected, support immediate safety and follow applicable safety and reporting requirements.

ACTION: Arrange prompt medical or mental health assessment when there is:

Suicide or self-harm thoughts: thoughts without immediate danger.
Substantial symptoms or effects: severe, persistent or worsening symptoms of depression, anxiety, trauma, possible psychosis or mania, eating problems or substance use that substantially affect daily life, decision-making or safe participation in care.
Other reasons for assessment: a marked change from usual behaviour or functioning; concern about medication or substance effects; a presentation outside the clinician’s competence; or a request for help.

Agree with the patient on who will be contacted, how soon and what to do if the situation worsens. Confirm that the person has connected with the service when clinically important.

ACTION: Adapt and coordinate MSK care:

Safe care: care may continue when it is safe and acceptable and does not delay needed assessment. Adapt communication, examination and care; obtain ongoing consent; and coordinate with other providers with the patient’s permission.
Continue the MSK assessment: do not assume that a mental health or substance use concern explains the MSK presentation. Continue to consider physical causes and the patient’s account.
Questionnaires: they may support conversation and monitoring, but do not establish a diagnosis or replace direct questions, clinical judgment or action.
Acceptable support: ask what type of help is acceptable and whether language, cultural, family, community or other supports are important to the patient.

ACTION: Document and follow up:

Record the concern; relevant questions and the patient’s responses; the safety decision and reasons; actions, advice and referrals; communication and consent; follow-up; and any unresolved concern. Follow applicable privacy, safety and reporting requirements.

For provincial, territorial and national services, see Mental health support: Get help (Public Health Agency of Canada 2026).

6. Yellow Flags: Factors that May Affect Recovery or Participation

Yellow Flags are personal, social, work, school, healthcare, environmental or structural factors that may influence symptoms, functioning, participation or response to care. They are contextual, not diagnoses or certain predictions, and do not mean that symptoms are psychological. They guide how care is tailored and do not by themselves require urgent referral. Explore them through conversation and ongoing outcome review, with attention to the patient’s priorities, strengths and circumstances. A separate Yellow Flag score is not required. New or worsening signs of serious physical illness follow the Red Flag process. Mental health or substance use concerns that need separate assessment, or any immediate safety concern, follow the Orange Flag process and applicable emergency or safeguarding procedures.

Explore relevant factors:

Understanding, expectations and healthcare experiences: concerns about injury or damage, uncertainty, recovery expectations, confidence, conflicting advice, previous dismissal or harm, and trust in care.
Responses to symptoms and activity: worry, fear, avoidance, cycles of doing too much and then needing prolonged rest, difficulty pacing, coping, sleep, confidence in self-management, and return to meaningful activities.
Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

7. Physical Examination

Observation:
- Inspect for abnormalities:
- Evaluate posture, balance, movements, gait patterns.
Range of motion (ROM):
- Assess active, passive, and resisted movements in flexion, extension, lateral flexion, and rotation.
- Consider post-surgical limitations, particularly in cases of instrumented fusion, where restrictions may be structural and non-modifiable.
Palpation:
- Examine bone and muscular areas for tenderness, swelling, muscle tightness, or temperature changes.
- Assess scar mobility and pain, as early scar mobilization may help prevent chronic post-surgical scar pain while avoiding keloid formation.
Neurological Examination:
- Compare preoperative and postoperative status to assess recovery of neurological deficits.
- Motor strength testing: Assess for asymmetry or weakness in key muscle groups:
  - L2: Hip flexors (hip flexion)
  - L3: Quadriceps (knee extension)
  - L4: Tibialis anterior (foot dorsiflexion)
  - L5: Extensor hallucis longus (big toe extension)
  - S1: Gastrocnemius (plantar flexion)
  - S2: Hamstrings (knee flexion)
- Sensory testing: Assess for dermatomal sensory deficits:
  - L3: Medial thigh at the knee
  - L4: Medial calf
  - L5: Top of foot and toes
  - S1: Lateral foot and little toe
- Reflex testing: Assess for asymmetry, diminished/absent reflexes:
  - L4: Patellar reflex
  - L5: Medial hamstring reflex
  - S1: Achilles reflex
- Balance testing: e.g. tandem gait, Romberg’s test.
Special/Orthopedic Tests: Select as appropriate based on clinical judgment, considering post-surgical stability.
Advanced Diagnostics:
- Radiography is not routinely recommended in the absence of red flags or specific individual factors (e.g. contraindications to treatment).
- Understand imaging limitations post-surgery due to hardware artifact:
  - MRI with contrast: Useful for detecting post-surgical scarring causing ongoing radicular symptoms.
  - CT scan: Useful for evaluating hardware failure.

8. Selection Considerations for Post-Lumbar-Surgery Rehabilitation

Individuals are eligible for this rehabilitation pathway if they meet the following criteria:

Pre-surgical condition:
- Individual underwent surgery for lumbar radiculopathy (due to disc herniation), neurogenic claudication (due to lumbar stenosis), or spondylolisthesis.
Surgical intervention:
- Applicable surgeries include:
  - Micro-discectomy (with or without endoscopic tubes)
  - Decompression with instrumented fusion
  - Discectomy with foraminectomy/foraminotomy
  - Foraminotomy
  - Discectomy with laminectomy, hemilaminectomy
  - Laminectomy with fusion
  - Lumbar intervertebral bone grafting and fusion (usually in the context of decompression and instrumented fusion)
  - Spinal fusion
  - Lumbar disc herniation nucleotomy
  - Lumbar transforaminal endoscopic surgery.
Signs/Symptoms: Individual exhibits no red flags (e.g., infection, post-surgical complications).
Post-surgical phase & rehabilitation timing:
- Microdiscectomy: Patients are typically cleared for rehabilitation by 6 weeks post-op.
- Fusion procedures: Patients are usually cleared within 10–12 weeks, depending on the extent of fusion.

9. Rehabilitation after Lumbar Spine Surgery

Approach to Treatment

The treatments outlined in this section reflect core domains of care consistently identified across high-quality sources and established clinical practices. These include interventions shown to improve patient-important outcomes such as pain, function, and quality of life. Management plans should be tailored to the individual’s needs, goals, and preferences, taking into account clinical presentation, response to care, and contextual factors.

Not all domains need to be included in every care plan or at every stage of recovery. Clinicians are expected to apply professional judgment in selecting the most relevant components based on the clinical context.

This pathway is not prescriptive, nor does it list every possible intervention. Readers are encouraged to consult individual guidelines for specific treatment protocols, dosage, and condition-specific considerations.

While a range of other interventions may be in use, such as passive physical modalities, these have mixed or limited evidence of clinical benefit and are therefore not recommended for routine use. If applied, such therapies should be used as adjuncts to the core, evidence-based components of care, and not as standalone treatment.

Communication with Surgeon
- Maintain a copy of the surgical report to inform treatment planning and ensure alignment with surgical outcomes. Consider preparing a brief summary note outlining the patient’s presentation and rehabilitation plan, which can be shared with the surgeon (either directly or via the patient) at their postoperative follow-up. Follow-up frequency varies by surgeon, so proactive communication may help bridge care.
Supervised Exercise Therapy (Yu et al., 2024; Manni et al. 2023)
- Develop individualized programs targeting core strength, mobility, posture, and reduction of kinesiophobia.
- Evidence supports benefits in pain reduction, improved function, and enhanced quality of life.
- Align programs with patient history, capabilities and goals.
- Monitor psychological responses to exercise; refer to medical/mental health providers if signs of distress or aversion arise.
- Early rehabilitation considerations:
  - Walking is typically recommended immediately post-op.
  - Isometric training (e.g., pelvic floor/Kegel exercises) may begin 10 days post-op if the incision is healed.
Education and Self-Management (Yu et al., 2024; Manni et al. 2023)
- Provide tailored, evidence-based information in various formats (written, digital, visual) to empower individuals.
- No single education type has demonstrated superiority; however, education should cover:
  - Pain education (understanding post-surgical pain, expectations, and coping strategies).
  - Scar education (healing timelines, scar mobilization, and pain management).
  - Movement education (safe post-surgical movement patterns and gradual return to activity).
  - Depression and anxiety-related concerns
- Combining education with supervised exercise may improve outcomes.
- Behavior graded activity, incorporating goal-setting and positive reinforcement, may help increase healthy behaviors and reduce pain.
- Home exercises may assist in reducing kinesiophobia.
- Address modifiable prognostic factors that may impact recovery.
  - Adoption of the “sick role” post-surgery may influence both recovery and prognosis.
Medication: (Consult a medical provider.) (Yu et al., 2024)
- Acetaminophen is commonly used for pain management post-surgery.
- NSAIDs are not commonly recommended post-surgically as they may interfere with healing and increase bleeding risk.
- Pregabalin is not recommended (may increase low back pain).
Scar Therapy & Wound Healing
- Scar mobilization techniques may help prevent chronic post-surgical scar pain if introduced at the appropriate stage of healing.
- Clinician-focused resources:
  - Wound Healing – Physiopedia
- Patient-focused resources:

10. Prognosis

Surgical intent and patient expectations: Surgery for low back pain (LBP) is not commonly performed, as most procedures target leg-related symptoms rather than chronic back pain itself. Many patients are not explicitly informed that surgery is unlikely to resolve LBP, leading to frustration when back pain persists post surgically despite improved leg symptoms. Presurgical education is critical to aligning expectations with likely outcomes and ensuring patient satisfaction.
Structural relief through surgery: While surgery can provide meaningful improvement for individuals with LBP related symptoms – particularly for clearly defined pathologies such as disc herniation with sciatica or spinal stenosis – it primarily addresses the mechanical aspect of the condition. Long-term pain relief depends on addressing functional impairments and contributing factors such as physical deconditioning and psychosocial influences.
Long-term success after surgery: Recovery outcomes are influenced by patient selection, presurgical expectations, and adherence to a structured postsurgical rehabilitation plan that includes physical conditioning, psychological support, and lifestyle modifications. Prehabilitation (“pre-hab”) interventions may enhance postsurgical recovery by improving strength, mobility, and overall surgical readiness.
Risk of persistent or recurrent symptoms: Some people experience prolonged or recurrent symptoms, sometimes referred to as ‘failed back surgery syndrome’ (FBSS). Factors associated with poorer outcomes include hypertension, intermittent claudication, Modic changes, unrealistic presurgical expectations, and inadequate functional improvement post-surgery.
Psychosocial influences and screening: Psychosocial factors – such as depression, anxiety, fear-avoidance beliefs, and catastrophizing – can affect post-surgical outcomes. Proactive screening before and after surgery, along with timely mental health referrals, can improve adherence to rehabilitation, reduce distress, and improve patient satisfaction.

(Krzanowska et al 2022; McIsaac et al 2025; Rushton et al 2018; Weinstein et al 2006, 2010; Xu et al 2022).

11. Ongoing Follow-up

Ongoing follow-up is a shared review of whether the plan remains safe, useful, acceptable and aligned with the patient’s goals. The timing of review should reflect symptoms, risk, the care being tried, goals and access rather than a fixed visit schedule.

Review symptoms and safety: ask what has changed in symptoms, functioning and daily activities; review adverse effects; and check for new or worsening Red Flags and relevant Orange or Yellow Flag concerns. Arrange earlier or urgent assessment when the findings require it.
Review outcomes: repeat the small set chosen at baseline and use the same measures when possible. These may include the Patient-Specific Functional Scale, WHODAS 2.0, quality of life using the patient’s own rating or a measure such as WHOQOL-BREF, symptom impact, participation and the patient’s own assessment of change. Interpret measures with the patient and alongside what has changed in daily life rather than relying on a score alone.
Review goals, preferences and consent: ask whether care remains acceptable, feasible and worthwhile; revisit goals and priorities; and confirm consent when the plan or circumstances change.
Adapt care: continue what is useful and acceptable, and change, pause or stop what is not. If progress is not sufficient from the patient’s perspective, review the clinical impression, the fit and amount of care, barriers to participation, other health or social factors and whether other expertise is needed.
Support self-management and participation: review the strategies the patient is using, including physical activity or exercise, symptom management, pacing and participation in work, school, caregiving, recreation or community life. Ask what is helping and which barriers can be addressed.
Referral and co-management: arrange emergency assessment for Red Flags requiring urgent care. Consider referral or co-management when findings or needs are beyond the clinician’s role, the patient’s condition is worsening, progress remains insufficient after the plan has been reviewed, or the patient requests another opinion.
Plan the next step: agree whether to continue, change the interval between visits, move toward more self-directed care, or apply the Criteria for Discharge section.

12. Criteria for Discharge

Discharge is a shared decision about ending or transferring a course of care. It does not require complete symptom resolution, a normal outcome score or a fixed number of visits.

When discharge may be appropriate: consider discharge when the patient’s goals have been met to a degree they consider satisfactory; the patient feels able to manage with less or no clinician involvement; the patient chooses to end care; continued care is not providing enough benefit to justify its burden, cost or time; or care is being transferred to another provider.
Reassess before discharge: review symptoms, functioning, participation, selected outcomes, goals, adverse effects, confidence and preferences. Check for new or worsening Red Flags and any Orange or Yellow Flag concerns that still require action. If the condition is worsening or a safety concern remains, arrange the required assessment or referral rather than routine discharge.
When progress has slowed: review the clinical impression, response to care, goals, barriers and access, other health or social factors, and other reasonable options before deciding with the patient whether to continue, change or end care.
Plan after discharge: agree on self-management, physical activity or exercise, symptom management, pacing and participation in work, school, caregiving, recreation or community life. Explain which changes should prompt earlier or urgent assessment and when and where to seek care.
Future access to care: explain how the patient can return if symptoms recur, functioning declines, or goals or demands change. Any planned future review or supportive care should have an agreed purpose, expected benefit and review point.
Referral or transfer: explain the reason, share a relevant summary with the patient’s consent, and clarify who will address outstanding concerns when possible. Avoid an unintended gap in care when safety or ongoing needs remain.
If the patient ends care or does not return: respect the patient’s right to stop. Record what is known and unknown about the outcome, advice or referral offered, attempts to communicate when clinically warranted, and any unresolved safety concern. Follow applicable record keeping and communication requirements.
Documentation: record the reason care ended, the patient’s status and selected outcomes, goals and preferences, unresolved concerns, advice and self-management plan, referral or transfer details, and how to seek care again if needed.

Rehabilitation after Lumbar Spine Surgery