Postoperative Mobilisierung und Belastung nach lumbalen Wirbelsäuleneingriffen

Zusammenfassung

Die postoperative Mobilisierung, Belastung und physiotherapeutische Behandlung ist ein wichtiger Bestandteil der Therapie von lumbalen Pathologien. Insbesondere physiotherapeutische und rehabilitative Behandlungen werden für die Verbesserung der klinischen Ergebnisse nach lumbalen spinalen operativen Eingriffen durchgeführt. Mehrere Studien haben den Einfluss der postoperativen Behandlung nach lumbalen Wirbelsäuleneingriffen untersucht. Die postoperative Behandlung nach lumbalen Wirbelsäulenoperationen wird allerdings bis heute nicht einheitlich durchgeführt. Der Anfang der physiotherapeutischen Behandlung nach dem Eingriff, die Dauer, Form und Intensität der physiotherapeutischen Behandlungen variieren in der internationalen Literatur. Ziel dieser Übersichtsarbeit ist Empfehlungen für die postoperative Behandlung von drei verschiedenen lumbalen spinalen Eingriffen (lumbale Bandscheibenoperation, lumbale stabilitätserhaltende Dekompressionsoperation und lumbale Fusionsoperation) in Bezug auf die Mobilisierung, Belastung und Rehabilitation anhand der aktuellen Studienlage und Erfahrung aus der eigenen Institution auszusprechen.

Abstract

Postoperative mobilization, weight-bearing, and physiotherapy treatment is an important component of therapy for lumbar pathology. Physiotherapeutic and rehabilitative treatments are performed for the improvement of clinical outcomes after lumbar spinal surgical procedures. Several studies have looked at the impact of postoperative treatment after lumbar spinal surgery. However, the exact postoperative treatment after lumbar spinal surgery remains inconsistent to date. The start of physiotherapy treatment after surgery, the duration, form and intensity of physiotherapy treatments vary in the international literature. The aim of this review is to make recommendations for the postoperative treatment of three different lumbar spinal surgeries (lumbar disc surgery, lumbar stability-maintaining decompression surgery, and lumbar fusion surgery) in terms of mobilization, loading, and rehabilitation based on current studies and experience from our own institution.

Schlüsselwörter

Postoperative Mobilisierung - Physiotherapie - Belastung nach Wirbelsäulenoperationen - Rehabilitation nach Wirbelsäulenoperationen

Keywords

Postoperative mobilisation - physiotherapy - weight-bearing after spine surgery - rehabilitation after spine surgery

Publication History

Article published online:
26 August 2022

• Literatur

• 1 McGregor AH, Dicken B, Jamrozik K. National audit of post-operative management in spinal surgery. BMC Musculoskelet Disord 2006; 7: 47 DOI: 10.1186/1471-2474-7-47. (PMID: 16737522)
• 2 Dolan P, Greenfield K, Nelson RJ. et al. Can exercise therapy improve the outcome of microdiscectomy?. Spine (Phila Pa 1976) 2000; 25: 1523-1532 DOI: 10.1097/00007632-200006150-00011. (PMID: 10851101)
• 3 Kulig K, Beneck GJ, Selkowitz DM. et al. Physical Therapy Clinical Research Network (PTClinRes. An intensive, progressive exercise program reduces disability and improves functional performance in patients after single-level lumbar microdiskectomy. Phys Ther 2009; 89: 1145-1157 DOI: 10.2522/ptj.20080052.. (PMID: 19778981)
• 4 Danielsen JM, Johnsen R, Kibsgaard SK. et al. Early aggressive exercise for postoperative rehabilitation after discectomy. Spine (Phila Pa 1976) 2000; 25: 1015-1020 DOI: 10.1097/00007632-200004150-00017. (PMID: 10767815)
• 5 Oosterhuis T, Ostelo RW, van Dongen JM. et al. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. J Physiother 2017; 63: 144-153 DOI: 10.1016/j.jphys.2017.05.016.. (PMID: 28668558)
• 6 McGregor AH, Doré CJ, Morris TP. et al. ISSLS prize winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER): a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved. Spine (Phila Pa 1976) 2011; 36: 1711-20 DOI: 10.1097/BRS.0b013e318214e3e6.
• 7 Erdogmus CB, Resch KL, Sabitzer R. et al. Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial. Spine (Phila Pa 1976) 2007; 32: 2041-2049
• 8 Ebenbichler GR, Inschlag S, Pflüger V. et al. Twelve-year follow-up of a randomized controlled trial of comprehensive physiotherapy following disc herniation operation. Clin Rehabil 2015; 29: 548-560 DOI: 10.1177/0269215514552032. (PMID: 25288048)
• 9 Newsome RJ, May S, Chiverton N. et al. A prospective, randomised trial of immediate exercise following lumbar microdiscectomy: a preliminary study. Physiotherapy 2009; 95: 273-279 DOI: 10.1016/j.physio.2009.06.004.
• 10 Kjellby-Wendt G, Styf J. Early active training after lumbar discectomy. A prospective, randomized, and controlled study. Spine (Phila Pa 1976) 1998; 23: 2345-2351
• 11 Millisdotter M, Strömqvist B. Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study. Eur Spine J 2007; 16: 19-26 DOI: 10.1007/s00586-005-0044-1. (PMID: 16421747)
• 12 Snowdon M, Peiris CL. Physiotherapy Commenced Within the First Four Weeks Post-Spinal Surgery Is Safe and Effective: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2016; 97: 292-301 DOI: 10.1016/j.apmr.2015.09.003. (PMID: 26409101)
• 13 Mundt DJ, Kelsey JL, Golden AL. et al. An epidemiologic study of non-occupational lifting as a risk factor for herniated lumbar intervertebral disc. The Northeast Collaborative Group on Low Back Pain. Spine (Phila Pa 1976) 1993; 18: 595-602
• 14 Smith JW, Walmsley R. Experimental incision of the intervertebral disc. J Bone Joint Surg Br 1951; 33-B: 612-625 DOI: 10.31083/j.fbl2704131. (PMID: 35468690)
• 15 Kim MS, Park KW, Hwang C. et al. Recurrence rate of lumbar disc herniation after open discectomy in active young men. Spine (Phila Pa 1976) 2009; 34: 24-29 DOI: 10.1097/BRS.0b013e31818f9116.
• 16 Bron JL, Helder MN, Meisel HJ. et al. Repair, regenerative and supportive therapies of the annulus fibrosus: achievements and challenges. Eur Spine J 2009; 18: 301-313 DOI: 10.1007/s00586-008-0856-x. (PMID: 19104850)
• 17 Carragee EJ, Han MY, Yang B. et al. Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions. Spine (Phila Pa 1976) 1999; 24: 2346-2351
• 18 Carragee EJ, Helms E, O'Sullivan GS. Are postoperative activity restrictions necessary after posterior lumbar discectomy? A prospective study of outcomes in 50 consecutive cases. Spine (Phila Pa 1976) 1996; 21: 1893-1897
• 19 Zoia C, Bongetta D, Alicino C. et al. Usefulness of corset adoption after single-level lumbar discectomy: a randomized controlled trial. J Neurosurg Spine 2018; 28: 481-485 DOI: 10.3171/2017.8.SPINE17370. (PMID: 29424674)
• 20 Zarghooni K, Beyer F, Siewe J. et al. The orthotic treatment of acute and chronic disease of the cervical and lumbar spine. Dtsch Arztebl Int 2013; 110: 737-742 DOI: 10.3238/arztebl.2013.0737.
• 21 Rushton A, Wright C, Goodwin P. et al. Physiotherapy rehabilitation post first lumbar discectomy: a systematic review and meta-analysis of randomized controlled trials. Spine (Phila Pa 1976) 2011; 36: E961-E972 DOI: 10.1097/BRS.0b013e3181f0e8f8.
• 22 Oosterhuis T, Costa LO, Maher CG. et al. Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev 2014; CD003007 DOI: 10.1002/14651858.CD003007. (PMID: 22972118)
• 23 Deyo RA, Gray DT, Kreuter W. et al. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 2005; 30: 1441-1445
• 24 Strömqvist B, Fritzell P, Hägg O. et al. Swespine: the Swedish spine register : the 2012 report. Eur Spine J 2013; 22: 953-74 DOI: 10.1007/s00586-013-2758-9. (PMID: 34629386)
• 25 Deyo RA, Mirza SK, Martin BI. et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010; 303: 1259-1265 DOI: 10.1001/jama.2010.338. (PMID: 20371784)
• 26 Jakola AS, Sørlie A, Gulati S. et al. Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study. BMC Surg 2010; 10: 34 DOI: 10.1186/1471-2482-10-34.
• 27 Mannion AF, Denzler R, Dvorak J. et al. A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J 2007; 16: 1101-1117
• 28 Aalto TJ, Leinonen V, Herno A. et al. Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up. Eur Spine J 2011; 20: 1331-1340 DOI: 10.1007/s00586-011-1781-y. (PMID: 34478814)
• 29 Connolly PJ, Grob D. Bracing of patients after fusion for degenerative problems of the lumbar spine--yes or no?. Spine (Phila Pa 1976) 1998; 23: 1426-1428 DOI: 10.3969/j.issn.1003-0034.2016.07.009. (PMID: 29232781)
• 30 Agabegi SS, Asghar FA, Herkowitz HN. Spinal orthoses. J Am Acad Orthop Surg 2010; 18: 657-667 (PMID: 32091743)
• 31 Bible JE, Biswas D, Whang PG. et al. Postoperative bracing after spine surgery for degenerative conditions: a questionnaire study. Spine J 2009; 9: 309-316 DOI: 10.1016/j.spinee.2008.06.453. (PMID: 18790685)
• 32 Bogaert L, Van Wambeke P, Thys T. et al. Postoperative bracing after lumbar surgery: a survey amongst spinal surgeons in Belgium. Eur Spine J DOI: 10.1007/s00586-018-5837-0. (PMID: 30488116)
• 33 Eisinger DB, Kumar R, Woodrow R. Effect of lumbar orthotics on trunk muscle strength. Am J Phys Med Rehabil 1996; 75: 194-197
• 34 Azadinia F, Takamjani EE, Kamyab M. et al. Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. Spine J 2017; 17: 589-602 DOI: 10.1016/j.spinee.2016.12.005.
• 35 McGregor AH, Burton AK, Sell P. et al. The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression. Eur Spine J 2007; 16: 339-346
• 36 Machado GC, Pinheiro MB. Early comprehensive physiotherapy after lumbar spine surgery (PEDro synthesis). Br J Sports Med 2018; 52: 96-97 DOI: 10.1136/bjsports-2017-098165. (PMID: 28831017)
• 37 Bae HW, Rajaee SS, Kanim LE. Nationwide trends in the surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976) 2013; 38: 916-926 DOI: 10.1097/BRS.0b013e3182833e7c.
• 38 Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991; 73: 802-808 (PMID: 2071615)
• 39 Kramer M, Katzmaier P, Eisele R. et al. Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine. Eur Spine J 2001; 10: 414-420
• 40 Gejo R, Matsui H, Kawaguchi Y. et al. Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976) 1999; 24: 1023-1028
• 41 Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976) 1996; 21: 941-944
• 42 Waschke A, Hartmann C, Walter J. et al. Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome--electromyographic and CT-volumetric investigation of 30 patients. Acta Neurochir (Wien) 2014; 156: 235-44 DOI: 10.1007/s00701-013-1981-9. (PMID: 24384989)
• 43 Cho SM, Kim SH, Ha SK. et al. Paraspinal muscle changes after single-level posterior lumbar fusion: volumetric analyses and literature review. BMC Musculoskelet Disord 2020; 21: 73 DOI: 10.1186/s12891-020-3104-0. (PMID: 32024500)
• 44 Bredow J, Löhrer L, Oppermann J. et al. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?. Biomed Res Int 2017; 2964529 DOI: 10.1155/2017/2964529. 2017. (PMID: 28831392)
• 45 Tarnanen S, Neva MH, Kautiainen H. et al. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disabil Rehabil 2013; 35: 134-139 DOI: 10.3109/09638288.2012.690496.
• 46 Lee CS, Kang KC, Chung SS. et al. How does back muscle strength change after posterior lumbar interbody fusion?. J Neurosurg Spine 2017; 26: 163-170 DOI: 10.3171/2016.7.SPINE151132. (PMID: 27740397)
• 47 Tarnanen SP, Neva MH, Häkkinen K. et al. Neutral spine control exercises in rehabilitation after lumbar spine fusion. J Strength Cond Res 2014; 28: 2018-2025 DOI: 10.1519/JSC.0000000000000334. (PMID: 24343327)
• 48 Virk SS, Niedermeier S, Yu E. et al. Adjacent segment disease. Orthopedics 2014; 37: 547-555 DOI: 10.3928/01477447-20140728-08. (PMID: 35695468)
• 49 Rushton A, Eveleigh G, Petherick EJ. et al. Physiotherapy rehabilitation following lumbar spinal fusion: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2012; 2 DOI: 10.1136/bmjopen-2012-000829. (PMID: 22833649)
• 50 Abbott AD, Tyni-Lenné R, Hedlund R. Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Spine (Phila Pa 1976) 2010; 35: 848-857 DOI: 10.1097/BRS.0b013e3181d1049f.
• 51 Monticone M, Ferrante S, Teli M. et al. Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial. Eur Spine J 2014; 23: 87-95 DOI: 10.1007/s00586-013-2889-z. (PMID: 23836299)
• 52 Christensen FB, Laurberg I, Bünger CE. Importance of the back-café concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up. Spine (Phila Pa 1976) 2003; 28: 2561-2569
• 53 Greenwood J, McGregor A, Jones F. et al. Rehabilitation Following Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2016; 41: E28-E36 DOI: 10.1097/BRS.0000000000001132.
• 54 Søgaard R, Bünger CE, Laurberg I. et al. Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy. Eur Spine J 2008; 17: 262-271 DOI: 10.1007/s00586-007-0479-7. (PMID: 17713794)
• 55 Oestergaard LG, Christensen FB, Nielsen CV. et al. Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial. Spine (Phila Pa 1976) 2013; 38: 1979-1985 DOI: 10.1097/BRS.0b013e3182a7902c.
• 56 Oestergaard LG, Nielsen CV, Bünger CE. et al. The effect of early initiation of rehabilitation after lumbar spinal fusion: a randomized clinical study. Spine (Phila Pa 1976) 2012; 37: 1803-1809
• 57 Yee AJ, Yoo JU, Marsolais EB. et al. Use of a postoperative lumbar corset after lumbar spinal arthrodesis for degenerative conditions of the spine. A prospective randomized trial. J Bone Joint Surg Am 2008; 90: 2062-2068 DOI: 10.2106/JBJS.G.01093. (PMID: 18829902)
• 58 Dailey AT, Ghogawala Z, Choudhri TF. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: brace therapy as an adjunct to or substitute for lumbar fusion. J Neurosurg Spine 2014; DOI: 10.3171/2014.4.SPINE14282. (PMID: 24980591)
• 59 Rohlmann A, Bergmann G, Graichen F. et al. Braces do not reduce loads on internal spinal fixation devices. Clin Biomech (Bristol, Avon) 1999; 14: 97-102
• 60 Rohlmann A, Bergmann G, Graichen F. Loads on internal spinal fixators measured in different body positions. Eur Spine J 1999; 8: 354-9 DOI: 10.1097/BRS.0b013e3181d55d52. (PMID: 20959780)
• 61 Rohlmann A, Wilke HJ, Graichen F. et al. Wirbelsäulenbelastung beim Sitzen auf einem Bürostuhl mit nach hinten kippbarer Rückenlehne. Biomed Tech (Berl) 2002; 47: 91-96