Zusammenfassung
Der systematische Review behandelt die Frage, welche kontrollierten klinischen Studien
die Effektivität bestimmter Vorgehensweisen in der postoperativen Rehabilitation bandscheibenoperierter
Patienten im Hinblick auf physiotherapeutisch relevante Parameter sowie Vorsichtsmaßnamen
und Kontraindikationen belegen.
Obwohl aufgrund der unterschiedlichen Studiendesigns ein direkter Vergleich nicht
möglich ist, ergeben sich starke Hinweise auf die Effektivität vorwiegend aktiver
physiotherapeutischer Übungsprogramme. Diese können bei komplikationslosem Verlauf
bereits ab dem 1. postoperativen Tag beginnen. Dynamische und durchaus auch mobilisierende
Komponenten zur Steigerung von Kraft und Kraftausdauer der Rumpfmuskulatur in Verbindung
mit einer ausreichend hohen Dosierung scheinen den günstigsten Einfluss zu haben.
Bei einer Dauer von 4 Wochen waren positive funktionelle Ergebnisse nachweisbar. Spätestens
ab der 3. postoperativen Woche sind kontrollierte aktive Mobilisationstechniken in
allen Bewegungsrichtungen möglich.
Da keine Anzeichen für eine erhöhte Rezidivrate oder postoperative Instabilitäten
sowie die Notwendigkeit von Aktivitätsbeschränkungen zu finden waren, scheint übertriebene
Vorsicht bei der Rehabilitation bandscheibenoperierter Patienten unbegründet.
Physiotherapy after lumbar disc surgery
The systematic review discusses the question of which controlled clinical studies
prove the effectiveness of certain interventions in the postoperative rehabilitation
of patients after lumbar disc surgery regarding parameters relevant to physiotherapy
as well as precautionary measures and contraindications.
Although a direct comparison is not possible due to differing study designs, there
are strong indications for the effectiveness of mainly active physiotherapy exercise
programmes. Dynamic and also mobilising components to increase the strength and endurance
of the trunk muscles together with a sufficiently high dosage seem to have the best
influence. Controlled active mobilising techniques in all directions of movement are
possible from not later than the 3rd postoperative week onwards.
As there were no indications for an increased rate of relapse or postoperative instability
as well as the necessity for activity restrictions, exaggerated caution during the
rehabilitation of patients after lumbar disc surgery seems to be unfounded.
Schlüsselwörter
Bandscheibenoperation - Physiotherapie
Key words
Lumbar disc surgery - Physiotherapy
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Peter Goerttler
Herbert Hellmann Allee 46
79189 Bad Krozingen
eMail: p.goerttler@web.de
