Lumbal Omurga Patolojilerinde Cerrahi Sonrası Fizyoterapi ve Rehabilitasyon
Özet
Lumbal bölge, omurganın biyomekanik açıdan en kritik yük taşıyıcı yapılarından biri olması nedeniyle disk herniasyonu, spondilolistezis, spinal stenoz, faset artropatisi, travma, enfeksiyon ve tümör gibi geniş bir patoloji spektrumuna yatkındır. Konservatif tedavilere yanıt vermeyen, ilerleyici nörolojik defisit gelişen veya omurga stabilitesini bozan olgularda cerrahi tedavi endikasyonu ortaya çıkar. Cerrahi öncesi dönemde uygulanan prehabilitasyon; motor kontrol, güçlendirme, aerobik kapasite ve psikososyal faktörlerin iyileştirilmesine yardımcı olarak ameliyat sonrası toparlanmayı destekleyebilir. Bölüm, ALIF, PLIF, TLIF, LLIF, OLIF gibi farklı füzyon tekniklerinin avantaj ve sınırlılıklarını ayrıntılı biçimde açıklamakta; ayrıca laminektomi, laminotomi, foraminotomi ve diskektomi gibi dekompresyon yöntemlerini karşılaştırmaktadır. Cerrahi sonrası oluşabilecek komplikasyonlar, değerlendirmede kullanılan fiziksel performans testleri ve hasta tarafından bildirilen ölçekler ayrıntılı biçimde sunulmuştur. Rehabilitasyon yaklaşımı; cerrahi tekniğe uygun doku iyileşmesi, ağrı yönetimi, postür eğitimi, lumbopelvik stabilizasyon, güçlendirme, mobilizasyon ve kademeli aktivite artışı temelinde yapılandırılır. Bilişsel-davranışçı müdahalelerin korku–kaçınma davranışlarını azaltmada etkili olduğu vurgulanmaktadır. Cerrahi müdahalenin uzun dönem etkinliğinin korunmasında multidisipliner, bireye özgü olarak yapılandırılmış rehabilitasyon programları, fonksiyonel kazanımların sürdürülmesi ve komplikasyon riskinin azaltılmasında önem taşımaktadır.
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