Chronische Rückenschmerzen – Physiotherapie oder Spondylodese zur Reduktion von Schmerz und Behinderung

Zusammenfassung

Hintergrund: 80 % der Schweizer leiden mindestens einmal im Jahr an Low Back Pain (LBP). Es ist unklar, ob Spondylodese oder konservative Therapie (Physiotherapie) bei chronischem LBP (CLBP) effektiver ist.

Ziel: Vergleich des Behandlungseffekts von konservativer Therapie (Physiotherapie) und Spondylodese bei LBP (spezifisch oder unspezifisch) hinsichtlich Schmerz und Behinderung.

Methode: Der systematische Review mit Literatursuche erfolgte in Pubmed, PEDro, Cochrane und CINAHL, die Risk-of-Bias-Analyse mit den PEDro-Kriterien (≥ 6/10 = gut).

Ergebnisse: Von 82 Publikationen erfüllten 10 alle Einschlusskriterien und betrafen 4 Studien. Von den 4 Studien hatten 3 ein geringes Risk of Bias. 2 Studien davon untersuchten Patienten mit Diskusdegeneration oder CLBP über 1 Jahr nach einer Diskushernienoperation. Das Outcome nach 1, 4 und 9 Jahren war nach konservativer Therapie (Physiotherapie mit kognitiven Übungen) und Spondylodese gleich gut. Eine 3. Studie mit einem höheren Risk of Bias zeigte nach 2 Jahren einen statistisch signifikanten, aber nicht klinisch relevanten Vorteil der Spondylodese. Laut der Ergebnisse der 4. Studie war bei isthmischer Spondylolisthesis die Spondylodese nach 2 Jahren effektiver als konservative Therapie (Physiotherapie mit kognitiven Übungen). Nach 5 – 13 Jahren ergab sich kein Unterschied.

Schlussfolgerungen: Bei CLBP aufgrund diskogener Ursache ist konservative Therapie (Physiotherapie mit kognitiven Übungen) bezüglich Schmerz und Behinderung gleich effektiv wie Spondylodese. Im Falle von CLBP bei isthmischer Spondylolisthesis erweist sich die Spondylodese bis 2 Jahre nach der Intervention als effektiver, wohingegen es nach durchschnittlich 9 Jahren keinen Unterschied bezüglich Schmerz und Behinderung zwischen den beiden Interventionen gibt.

Abstract

Background: Eighty per cent of Swiss citizens suffer of low back pain (LBP) at least once a year. It is unclear whether spondylodesis or conservative therapy (physiotherapy) is more effective in chronic LBP (CLBP).

Objective: Comparison of treatment effects of conservative therapy (physiotherapy) and spondylodesis in CLBP (specific and nonspecific) related to pain and disability.

Method: This systematic review following literature search was performed in Pubmed, PEDro, Cochrane and CINAHL, the risk of bias analysis using PEDro criteria (≥ 6/10 = good).

Results: 10 out of 82 publications fulfilled all inclusion criteria and were related to 4 studies. 3 out of the 4 studies had a low risk of bias. 2 studies investigated patients with disc degeneration or CLBP more than 1 year after disc herniation surgery. The outcome showed no difference between spondylodesis and conservative therapy (physiotherapy with cognitive therapy) after 1, 4 and 9 years. A third study with a higher risk of bias demonstrated a statistically significant but not clinically relevant advantage of spondylodesis after 2 years. According to the 4^th study in patients with isthmic spondylolisthesis after 2 years spondylodesis was more effective than conservative therapy (physiotherapy with cognitive therapy). After 5 – 13 years there was no outcome difference.

Conclusions: In CLBP due to discogenic causes conservative therapy (physiotherapy with cognitive therapy) is as effective as spondylodesis in reducing pain and disability. In the case of CLBP in isthmic spondylolisthesis spondylodesis is more effective than physiotherapy up to 2 years following intervention whereas there is no difference between both interventions with respect to pain and disability after 9 years on average.

Schlüsselwörter

chronische lumbale Rückenschmerzen - Physiotherapie - Bewegungstherapie - Spondylodese - systematischer Review

Key words

chronic low back pain - physiotherapy - exercise therapy - spondylodesis - systematic review

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