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Sportliche Belastungen nach Spondylodesen der Lendenwirbelsäule

Der Return-to-play-Prozess

Athletic competition following lumbar spinal fusion

The return-to-play decision process

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An Erratum to this article was published on 05 March 2015

Zusammenfassung

Hintergrund

Die Wiederaufnahme von Wettkampfaktivitäten ist für Athleten nach Spondylodesen von zentraler Bedeutung. Empfehlungen zu Bedingungen und Zeitpunkt auf Basis systematischer Untersuchungen liegen bis dato nicht vor.

Ziel

Das Ziel der Arbeit ist es, eine Übersicht hinsichtlich Zeitpunkt und Kriterien der Rückkehr zur sportlichen Aktivität bei Erwachsenen nach degenerationsbedingter Fusionsoperation im LWS-Bereich bereitzustellen.

Material und Methode

Zwei unabhängige Untersucher recherchierten relevante Literatur unter Einbezug von MeSH-Terms in MEDLINE. Zielgrößen waren der Zeitpunkt sowie die Entscheidungskriterien für die Rückkehr zu sportlicher Aktivität („return to play“, RTP).

Ergebnisse

Aktuell sind keine randomisiert kontrollierten Studien zu RTP nach spinaler Fusion unter Beachtung der Ein- und Ausschlusskriterien veröffentlicht. Fünf der eingeschlossenen Studien basieren auf Originaldaten, größtenteils handelt es sich um narrative Übersichtsarbeiten mit geringem Evidenzniveau. Zusätzlich zu den Übersichtsarbeiten liegen eine Beobachtungsstudie, zwei Expertenbefragungen und zwei Modellentwicklungen bzw. -bewertungen vor.

Schlussfolgerungen

Patienten müssen nach einer spinalen Fusionsoperation für eine positive RTP-Entscheidung literaturbasiert folgende Kriterien erfüllen: 1) Abgeschlossene Remodellierung der betroffenen Gewebe, 2) Gewährleistung der Sicherheit des Athleten und anderer Personen im Rahmen des Trainings und Wettkampfes, 3) Wiederausbildung sportartspezifischer Fähigkeiten und 4) psychosoziale Bereitschaft für RTP. RTP kann bereits 6 Monate postoperativ angestrebt werden; evtl. ist eine Rückkehr zu Vollkontakt- bzw. kollisionsgefährdeten Sportarten kontraindiziert.

Abstract

Background

Return to play (RTP) and competition following spinal fusion is of particular importance for athletes. There is a lack of guidelines for decision making in RTP processes.

Objective

The purpose of this work was to provide a systematic review of the criteria and time of return in the RTP decision process for adults undergoing lumbar spinal fusion.

Methods

Two independent investigators searched MEDLINE using MeSH terms. Targeted outcomes were criteria for return to play decisions and total duration of the RTP process.

Results

So far, no prospective randomized controlled trials on RTP after spinal fusion considering inclusion and exclusion criteria are available. Five of the included studies are based on original data. Most of the identified studies are narrative reviews and, thus, exhibit low evidence levels. In addition to the narrative reviews, one observational study, two expert opinion surveys and two model development studies were found.

Conclusion

Based on the literature research, a positive RTP decision can be made if the following criteria are fulfilled: (1) anatomical and functional healing is complete, (2) safety of the athlete and secondary subjects during training and competition is guaranteed, (3) sport-specific skills are regained, and (4) patient is psychosocially ready. The RTP process can often be successfully initiated 6 months after surgery; some patients however, will never manage the return to full-contact sports and/or sports with risk of collision.

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Authors and Affiliations

  1. Abteilung Sportmedizin, Goethe-Universität Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Deutschland

    D. Niederer, J. Wilke, E. Füzéki & W. Banzer

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  1. D. Niederer
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  2. J. Wilke
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  3. E. Füzéki
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  4. W. Banzer
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Correspondence to D. Niederer.

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D. Niederer, J. Wilke, E. Füzéki und W. Banzer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Niederer, D., Wilke, J., Füzéki, E. et al. Sportliche Belastungen nach Spondylodesen der Lendenwirbelsäule. Orthopäde 43, 1100–1105 (2014). https://doi.org/10.1007/s00132-014-3038-z

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