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Maayan O, Zhang B, Fourman MS, Clohisy J, Pajak A, Nakarai H, Kazarian GS, Du J, Merrill R, Kaidi A, Knopp R, Akosman I, Samuel J, Andrews L, Shahi P, Lovecchio FC, Kim HJ. Return to Sporting Activities Following Long Fusions to the Pelvis in Adult Spinal Deformity. Spine J 2024:S1529-9430(24)00268-7. [PMID: 38871060 DOI: 10.1016/j.spinee.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND CONTEXT Returning to recreational sporting activities after adult spinal deformity (ASD) correction may significantly impact the patient's perceived quality of life. PURPOSE This study sought to characterize participation in sporting activities before and after ASD surgery, and to identify factors associated with impaired return to sports. STUDY DESIGN Cross-sectional survey and retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent posterior-only thoracolumbar ASD surgery between 2016-2021 with ≥1 year follow-up and ≥3 levels of fusion to the pelvis were included. OUTCOME MEASURES Preoperative and postoperative participation in sports, timing of return to these activities, and reasons for limited sports participation postoperatively were assessed. METHODS A survey was used to evaluate outcome measures. Differences in demographic, surgical, and perioperative variables between patients who reported improved, unchanged, or worsened activity tolerance were evaluated. RESULTS Ninety-five patients were included (mean age: 64.3±10.1 years; BMI: 27.3±6.1 kg/m2; median levels fused: 7). The survey was completed at an average of 43.5 ± 15.9 months after surgery. Sixty-eight (72%) patients participated in sports preoperatively. The most common sports were swimming (n=33, 34.7%), yoga (n=23, 24.2%), weightlifting (n=20, 21.1%), elliptical (n=19, 20.0%), and golf (n=11, 11.6%). Fifty-seven (83.8%) returned to at least one sport postoperatively, most commonly 6-12 months after surgery (45%). Elliptical had the highest rate of equal or improved participation (53%). Patients generally returned below their preoperative level to all other sports. Reasons for reduced sporting activities included physical limitation (51.4%), fear (20.0%), pain (17.1%), and surgeon advice (8.6%). There were no differences in the demographic, surgical, or perioperative characteristics between those who returned to sports at the same or better level compared with those who returned at a lower level. CONCLUSIONS 84% of patients successfully resumed sporting activities after undergoing fusion to the sacrum/pelvis for ASD. However, this return is typically at a lower level of participation than their preoperative participation, particularly in higher demand sports. Understanding trends in sporting activity may be valuable for counseling patients and setting expectations.
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Affiliation(s)
- Omri Maayan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Bo Zhang
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Mitchell S Fourman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Montefiore Einstein, 1250 Waters Pl, Tower 1, 11th Fl, Bronx, NY 10461, USA
| | - John Clohisy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Anthony Pajak
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Hiroyuki Nakarai
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Gregory S Kazarian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jerry Du
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Robert Merrill
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Austin Kaidi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Rachel Knopp
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Izzet Akosman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Justin Samuel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Leah Andrews
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Pratyush Shahi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | | | - Han Jo Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Hung NJ, McClellan RT, Hsu W, Hu SS, Clark AJ, Theologis AA. Timelines for Return to Different Sports Types After Eight Cervical Spine Fractures in Recreational and Elite Athletes: A Survey of the Association for Collaborative Spine Research. Clin Spine Surg 2024:01933606-990000000-00282. [PMID: 38531829 DOI: 10.1097/bsd.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Prospective cross-sectional survey. OBJECTIVE To identify timelines for when athletes may be considered safe to return to varying athletic activities after sustaining cervical spine fractures. BACKGROUND While acute management and detection of cervical spine fractures have been areas of comprehensive investigation, insight into timelines for when athletes may return to different athletic activities after sustaining such fractures is limited. METHODS A web-based survey was administered to members of the Association for Collaborative Spine Research that consisted of surgeon demographic information and questions asking when athletes (recreational vs elite) with one of 8 cervical fractures would be allowed to return to play noncontact, contact, and collision sports treated nonoperatively or operatively. The third part queried whether the decision to return to sports was influenced by the type of fixation or the presence of radiculopathy. RESULTS Thirty-three responses were included for analysis. For all 8 cervical spine fractures treated nonoperatively and operatively, significantly longer times to return to sports for athletes playing contact or collision sports compared with recreational and elite athletes playing noncontact sports, respectively (P< 0.05), were felt to be more appropriate. Comparing collision sports with contact sports for recreational and elite athletes, similar times for return to sports for nearly all fractures treated nonoperatively or operatively were noted. In the setting of associated radiculopathy, the most common responses for safe return to play were "when only motor deficits resolve completely" and "when both motor and sensory deficits resolve completely." CONCLUSIONS In this survey of spine surgeons from the Association for Collaborative Spine Research, reasonable timeframes for return to play for athletes with 8 different cervical spine fractures treated nonoperatively or operatively varied based on fracture subtype and level of sporting physicality.
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Affiliation(s)
- Nicole J Hung
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles
| | - Robert Trigg McClellan
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA
| | - Wellington Hsu
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Serena S Hu
- Department of Orthopaedic Surgery, Stanford University, Stanford
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA
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Bäcker HC, Johnson MA, Hanlon J, Chan P, Turner P, Cunningham J. Return to sports following discectomy: does a consensus exist? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:111-117. [PMID: 37280437 DOI: 10.1007/s00586-023-07776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In the USA, lumbar discectomy is one of the most commonly performed spinal procedures. As certain sports are considered to be major risk factors for disc herniation, the question remains as to when highly active patients should return to their previous level of activity. This study aimed to analyze spine surgeons' opinions on when patients may return to activities following discectomy as well as their underlying rationale for their decision. METHODS A questionnaire was designed by five different fellowship-trained spine surgeons for the 168 members of the Spine Society of Australia. Questions on the surgeons experience, decision making, preferred surgical technique, the postoperative rehabilitation and the response to patient expectations were included. RESULTS In total, 83.9% of surgeons discuss the postoperative level of activity with their patients. Sport is considered as an important contributor for good functional outcome by 71.0% of surgeons. Surgeons recommend avoiding, often permanently, weightlifting (35.7%) of the time, rugby (21.4%), horseback riding (17.9%) as well as martial arts (14.3%) postoperatively even with previous training. The return to high levels of activity is considered as a major risk factor for disc herniation recurrence by 25.8% of surgeons. Return to high level of activity is typically recommended after 3 months by 48.4% of surgeons. CONCLUSION So far no consensus on the rehabilitation protocol and return to level of activity exists. Recommendations depend on personal experience as well as the individuals' training, and typically, a period of avoidance of sport for up to 3 months is recommended. LEVEL OF EVIDENCE Level III, therapeutic and prognostic study.
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Affiliation(s)
- Henrik C Bäcker
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville VIC 3050, Melbourne, Australia.
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia.
- Department of Orthopaedic Surgery, Auckland City Hospital, Grafton, New Zealand.
| | - Michael A Johnson
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
| | - Jack Hanlon
- Department of Orthopaedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - Patrick Chan
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
- Department of Neurosurgery, Alfred Health, 315, Victoria, 3181, Prahran, Australia
| | - Peter Turner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville VIC 3050, Melbourne, Australia
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
| | - John Cunningham
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville VIC 3050, Melbourne, Australia
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
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Theologis AA, Cummins DD, Kato S, Lewis S, Shaffrey C, Lenke L, Berven SH. Activity and sports resumption after long segment fusions to the pelvis for adult spinal deformity: survey results of AO Spine members. Spine Deform 2023; 11:1485-1493. [PMID: 37462878 PMCID: PMC10587314 DOI: 10.1007/s43390-023-00734-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To assess recommendations for when adult spinal deformity (ASD) patients may return to athletic activities after surgery. METHODS A web-based survey was administered to members of AO Spine. The survey consisted of surgeon demographic information and questions asking when a patient undergoing a long thoracolumbar fusion (> 5 levels) with pelvic fixation for ASD would be allowed to resume unrestricted range of motion (ROM), non-contact sports, and contact sports postoperatively. Ordinal logistic regression was used to determine predictors for time to resume each activity. RESULTS One hundred twenty four members' responses were included for analysis. The majority of respondents would allow unrestricted ROM within 3 months postop (< 3 months: 81% vs > 3 months: 19%]. For when to return to non-contact sports, the most common responses were "2-3 months" (26.6%), "3-4 months" (26.6%), and "6-12 months" (18.5%). For when to return to contact sports, the majority advised > 4 months postop [> 4 months: "4-6 months" (19.2%), "6-12 months" (28.0%), " > 12 months" (28.8%) versus < 4 months: "1-2 months" (4.0%), "2-3 months" (1.6%), "3-4 months" (8.8%)]. 8.8% responded they would "never" allow resumption of contact sports. CONCLUSION There was significant variation between surgeons' recommendations for resumption of unrestricted range of motion and sports following long fusion with pelvic fixation for ASD. An evidence-based approach to activity recommendations will require information on outcomes and complications.
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Affiliation(s)
- Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA.
| | - Daniel D Cummins
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Stephen Lewis
- Department of Surgery and Spine Program, University of Toronto, Toronto, ON, Canada
| | | | - Lawrence Lenke
- Department of Orthopedic Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
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Ackermans T, Schelfaut S, Beeckman M, Michielsen J, Moens P, Goubert L, Plasschaert F. Monitoring the initial recovery after fusion surgery using activity trackers in adolescent idiopathic scoliosis: going in the lumbar spine decreases the daily step count. Spine Deform 2023; 11:927-932. [PMID: 37000346 DOI: 10.1007/s43390-023-00677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Although the functional outcome (e.g. the return to daily activities) plays an important role in the evaluation of treatment success for the paediatric patient, clinicians currently cannot make accurate and objective predictions regarding the very early (≤ 6 weeks) functional outcome and its recovery over time. The purpose of the present study is to objectively measure initial postoperative physical activity levels and examine the relationship with patient characteristics, fusion levels and pain. METHODS Step count (SC) was obtained pre- (Pre-Op) and postoperatively (Post-3W: 3 weeks after surgery; Post-6W: 6 weeks after surgery) using an accelerometer. Patients were grouped based on LIV (thoracic (T-group) and lumbar (L-group)) and fusion length (FL ≤ 10 levels = SF-group and FL ≥ 11 levels = LF-group). Differences in the daily SC between groups (LIV and FL) and the three timepoints was investigated using a two-way ANOVA. RESULTS The SC was significantly lower at both Post-3W (p < 0.001) and Post-6W (p < 0.001) compared to the preoperative SC, and significantly (p < 0.001) increased from Post-3W to Post-6W (Pre-Op = 13,049 ± 3214 steps/day; Post-3W = 6486 ± 2925 steps/day; Post-6W = 8723 ± 3020 steps/day). At both post-op timepoints the T-group had a higher SC compared to the L-group. CONCLUSION A fusion surgery with the LIV at L2 or below has a negative impact on the very early postoperative activity levels. The initial functional outcome level of AIS patients was not related to the presently collected patient characteristics. This suggests that objective activity trackers provide novel information and could have an added value in very early rehabilitation programs.
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Affiliation(s)
- Thijs Ackermans
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Sebastiaan Schelfaut
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Melanie Beeckman
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Jozef Michielsen
- Department of Orthopedics, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Pierre Moens
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Frank Plasschaert
- Department of Orthopedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Fabricant PD, Pascual-Leone N, Gross PW, Retzky JS, Green DW, Blanco JS, Widmann RF. High Rates of Successful Return to Competitive Athletics After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Regardless of Distal Fusion Level: A Prospective Cohort Study. Spine (Phila Pa 1976) 2023; 48:737-741. [PMID: 36763834 DOI: 10.1097/brs.0000000000004599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To determine if distal spinal fusion level is associated with postoperative sport participation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The concept of "saving a level" during PSF for AIS refers to minimizing the distal extent of lumbar fusion to theoretically allow for increased postoperative spinal mobility and a more predictable return to athletic activity, as well as minimizing the risk of degenerative disc disease. There are few prospective studies evaluating the correlation between distal fusion level and timing of return to sports. MATERIALS AND METHODS Adolescent patients undergoing PSF for AIS between 2009 and 2019 were approached at their presurgical visit to participate in this prospective study. Participants were followed for a minimum of 2 years after surgery. Sports participation (classified by sport type and level of competitiveness) and radiographic data were collected at the initial visit. At each postoperative visit, it was noted whether patients returned to the same sport type and level of competitiveness. RESULTS After an a priori power calculation was performed, a total of 106 participants were included in the analysis with a mean age of 14 ± 2 years. Distal fusion levels ranged from T11 to L4. There was no significant association between distal fusion level and return to the same level of sports participation ( P = 0.192). Of the participants, 93% returned to sports with no significant differences by distal fusion level ( P = 0.081). Distal fusion level demonstrated no difference in return to preoperative sport ( P = 0.486) or return to the same type of sport ( P = 0.247). CONCLUSIONS This study found no association between distal fusion level and postoperative sports participation. Even though many patients may elect to change sports, nearly all patients returned to sports, and the majority of patients returned to the same level of sports competition or higher after PSF for AIS.
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Affiliation(s)
| | - Nicolas Pascual-Leone
- Hospital for Special Surgery, New York, NY
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Tetreault T, Darland H, Vu A, Carry P, Garg S. Adolescent athletes return to sports rapidly after posterior spine fusion for idiopathic scoliosis: a prospective cohort study. Spine Deform 2023; 11:383-390. [PMID: 36197603 DOI: 10.1007/s43390-022-00592-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/17/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE No consensus exists regarding the timing for return to sports after PSF for patients with AIS. Return-to-play protocols are based on expert opinion and vary widely. The purpose of this study was to determine how rapidly athletes return to baseline sports activity following posterior spinal fusion for adolescent idiopathic scoliosis. METHODS Athletes were consecutively enrolled. Inclusion criteria included competition at a junior varsity level or greater for ≥ 3 months yearly, major Cobb angle of 40-75°, age 10-18 years, and one year of follow-up. Athletes completed preoperative sports performance and Patient Reported Outcomes Measurement Information System (PROMIS) physical activity, pain interference, and depressive symptoms questionnaires. Self-assessments were repeated monthly until one year after PSF. RESULTS Twenty-six athletes were enrolled. The median time to return to sport was 2.7 months [range: 0.6-13 months]. At twelve months, 24 of 26 [90.1%; 95% CI 36.9-74.9%] athletes reported they had returned to the sport at their presurgical level of play. Participation in contact sports was associated with a longer return to sport relative to participation in non-contact/limited contact sports [Hazard Ratio: 0.37, 95% 95% CI 0.14-0.97, p = 0.0427]. Conditioning and flexibility were the most common barriers to return to sport. CONCLUSIONS When released to unrestricted activity at 4-8 weeks, athletes rapidly return to baseline levels of sports performance, with over half achieving this metric by 3 months.
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Affiliation(s)
- Tyler Tetreault
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hannah Darland
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA
| | - Angela Vu
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA
| | - Patrick Carry
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA
| | - Sumeet Garg
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA.
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Return to Sport after Adolescent Idiopathic Scoliosis (AIS) Correction Surgery: A Retrospective Data Analysis. J Clin Med 2023; 12:jcm12041551. [PMID: 36836086 PMCID: PMC9958665 DOI: 10.3390/jcm12041551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Sports are relevant to younger populations in society. Adolescent idiopathic scoliosis (AIS) patients who undergo surgical correction of the spine are often intensively involved in sports. For that, returning to the sport is often an important concern for the patients and their families. To the best of our knowledge, there is still a lack of scientific data indicating established recommendations about the time of returning to sport activities after surgical spinal correction. The aim of this study was to investigate (1) when AIS patients return to athletic activities after a posterior fusion, and (2) if they change their activities postoperatively. Furthermore, another question was (3) if the length of the performed posterior fusion or (4) fusion to the lower lumbar spine could have an influence on the rates or time of returning to sport activities postoperatively. Data collection was performed using questionnaires assessing patients' contentment and athletic activity. Athletic activities were categorized into three categories: (1) contact, (2) contact/non-contact and (3) non-contact sports. The intensity of exercised sports, the time of returning to the sport and changes in sport habits were documented. Radiographs were evaluated pre- and postoperatively to determine the Cobb angle and the length of the posterior fusion via the identification of the upper (UIV) and lower instrumented vertebra (LIV). Stratification analysis due to the fusion length was performed to answer a hypothetical question. This retrospective survery of 113 AIS patients treated with a posterior fusion revealed that, on average, returning to sport activities required 8 months of postoperative rest. The preoperative to postoperative rate of patients participating in sport activities increased from 88 (78%) to 94 (89%). Furthermore, postoperatively, a relevant shift of exercised activities from contact to non-contact sports was noted. Further subanalysis revealed that only 33 subjects were able to return to exactly the same athletic activities as before surgery (10 months postoperatively). The assessment of radiographs revealed that in this study group, the length of the performed posterior fusion and fusions to the lower lumbar spine had no influence on the time of return to athletic activities. The results of this study might shed some light on postoperative recommendations for sport activities after AIS treatment with a posterior fusion and may be beneficial for surgeons treating patients.
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Tetreault TA, Garg S. Return to play following spine surgery. Front Pediatr 2023; 11:1176563. [PMID: 37138567 PMCID: PMC10150059 DOI: 10.3389/fped.2023.1176563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Abstract
Return to physical activity is a primary concern for adolescents with idiopathic scoliosis who are indicated for spinal fusion surgery. Preoperative counseling often addresses questions regarding ability to return to sport, postoperative restrictions, time away from play, and the safety of returning to activities. Previous works have shown that flexibility can noticeably decrease after surgery, and that the ability to return to the same level of play may be impacted by the levels of the spine included in the fusion. Equipoise remains on when patients should be allowed to return to non-contact, contact, and collision play; however, there is a trend toward earlier release to activities over the last few decades. Sources agree, though, that returning to play is safe, with rare instances of complications reported for patients with spinal fusion. Here, we review the literature on the function of spinal fusion levels on flexibility and biomechanics, address factors that may influence one's recovery of sports performance, and discuss safety considerations regarding return play following spine surgery.
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Ruffilli A, Barile F, Viroli G, Manzetti M, Traversari M, Ialuna M, Bulzacki Bogucki BD, Faldini C. Return to sport after posterior spinal fusion for adolescent idiopathic scoliosis: what variables actually have an influence? A retrospective study. Spine Deform 2022; 10:1367-1374. [PMID: 35723854 PMCID: PMC9579079 DOI: 10.1007/s43390-022-00535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To retrospectively evaluate a cohort of athletically active patients who underwent surgery for adolescent idiopathic scoliosis (AIS), and to determine which clinical, surgical and anthropometric variables influenced their return to sport after surgery. METHODS 112 adolescents who underwent high-density posterior fusion for AIS by a single surgeon were analyzed for clinical, surgical and demographic predictors of return to presurgical physical activity levels. Data were retrospectively collected by charts and X-rays analysis and patients interviews. RESULTS Preoperative main curve Cobb was 64.4 ± 14.12° and obtained correction was 70.0 ± 12.5%. Included patients played many different sports (Table 4), most of all ballet (44/112, 39.2%), swimming (40/112, 35.7%) and gymnastics (32/112, 28.6%). At an average of 50.3 months follow-up, 76 (67.8%) patients returned to sports (RTS) at an equal or higher level than preoperatively. Younger age, lower Lenke curve type and lower main curve Cobb were significantly associated with RTS. As for RTS timing, patients who returned within the first 6 months were younger, with a higher Lenke and a less severe main curve, a more distal UIV and a more proximal LIV. No complications related to RTS were registered. CONCLUSION In conclusion, patients with adolescent idiopathic scoliosis safely returned to physical activity after surgery. Younger age, higher Lenke type and lower main curve severity predicted a quicker return to sport. However, prospective studies are needed to confirm these findings.
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Affiliation(s)
- Alberto Ruffilli
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Ialuna
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Bartlomiej Dobromir Bulzacki Bogucki
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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11
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Oba H, Ikegami S, Uehara M, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Koseki M, Takahashi J. Impact of Physical Flexibility Changes on Respiratory Function after Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Surgery. Spine Surg Relat Res 2022; 7:52-59. [PMID: 36819624 PMCID: PMC9931405 DOI: 10.22603/ssrr.2022-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Corrective scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) increases thoracic volume but does not improve respiratory function (RF). This study evaluates the effect of physical flexibility (PF) improvement after scoliosis surgery on RF. Methods This study reviewed the records of 61 consecutive patients with AIS (56 female and 5 male; mean±standard deviation age: 14.8±2.2 years, range: 11-20 years) who had undergone posterior spinal fusion (PSF) of the thoracic curve. PF evaluated as finger-floor distance (FFD) was measured preoperatively and one year after surgery. After dividing the cohort into the PF improvement group and the PF nonimprovement group, RF changes at two years postoperative were statistically compared. Using logistic regression analysis, we evaluated the impact of a PF improvement on % forced vital capacity (%FVC) two years after surgery. Results The rate of patients with increased FVC, %FVC, and forced expiratory volume 1.0 second two years after surgery was 79%, 51%, and 80%, respectively. The PF improvement group exhibited a significantly higher gain in %FVC versus the PF nonimprovement group (P=0.043). Moreover, PF improvement significantly prevented a %FVC decrease (odds ratio 8.43, 95% confidence interval 1.92-59.70; P<0.001), with an adjusted odds ratio of 11.86 (P<0.001). Conclusions Patients with diminished PF after PSF for AIS may be less likely to achieve postoperative %FVC improvement. As increased postsurgical %FVC had a positive effect on physical function, treatment strategies that focus on maintaining and increasing PF are desirable from an RF viewpoint.
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Affiliation(s)
- Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Daisuke Kurogouchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Michihiko Koseki
- Faculty of Textile Science and Technology, Shinshu University, Ueda, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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12
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Pahys JM, Samdani AF, Hwang SW, Warshauer S, Gaughan JP, Chafetz RS. Trunk Range of Motion and Patient Outcomes After Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: Comparison Using Computerized 3D Motion Capture Technology. J Bone Joint Surg Am 2022; 104:1563-1572. [PMID: 35766407 DOI: 10.2106/jbjs.21.00992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior vertebral body tethering (AVBT) for adolescent idiopathic scoliosis (AIS) is postulated to preserve motion compared with traditional posterior spinal fusion (PSF), but few studies exist to date. We used a validated computerized 3D model to compare trunk motion between patients treated with PSF and AVBT, and analyzed trunk motion in relation to the lowest instrumented vertebra (LIV). METHODS This was a single-center retrospective review of a consecutive series of skeletally immature patients with AIS who underwent motion analysis prior to PSF (n = 47) or AVBT (n = 65) and 2 years postoperatively. Patients were divided into 4 groups on the basis of the LIV (≤L1, L2, L3, L4). Computerized 3D kinematic evaluations included thoracic and lumbar flexion, extension, side-bending, and rotation. Patient outcomes were assessed using the Scoliosis Research Society (SRS)-22 questionnaire. RESULTS The LIV was ≤L1 in 48 patients treated with AVBT and 23 treated with PSF, L2 in 4 AVBT and 8 PSF patients, L3 in 10 AVBT and 8 PSF patients, and L4 in 3 AVBT and 8 PSF patients. PSF patients had a significant loss of motion in all 4 directions at 2 years postoperatively (e.g., flexion loss was 11° for ≤L1 to 30° for L4; p < 0.001). This equated to a 7° loss of trunk flexion per additional LIV level included in the fusion. AVBT patients only demonstrated loss of flexion and side-bending at 2 years postoperatively (e.g., flexion loss of 11° for L1 to 17° for L4; p < 0.001). Preoperative curve size and flexibility did not have any significant impact on differences in trunk motion between AVBT and PSF. SRS-22 scores were predominantly similar for AVBT versus PSF preoperatively and at 2 years postoperatively. CONCLUSIONS Patients treated with AVBT experienced predominantly less motion loss compared with PSF patients at 2 years postoperatively. Patients treated with PSF demonstrated loss of motion in all planes that increased with each additional LIV from ≤L1 to L4, with 7° loss of flexion per additional LIV. However, the differences in total trunk motions were relatively modest for PSF and AVBT with an LIV of ≤L1. Preoperative curve magnitude and flexibility had no significant impact on trunk motion in either group. SRS-22 scores were similar for both groups at 2 years postoperatively. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joshua M Pahys
- Shriners Children's Philadelphia, Philadelphia, Pennsylvania
| | - Amer F Samdani
- Shriners Children's Philadelphia, Philadelphia, Pennsylvania
| | - Steven W Hwang
- Shriners Children's Philadelphia, Philadelphia, Pennsylvania
| | | | - John P Gaughan
- Cooper Research Institute at Cooper University Hospital, Camden, New Jersey
| | - Ross S Chafetz
- Shriners Children's Philadelphia, Philadelphia, Pennsylvania
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13
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Early operative morbidity in 184 cases of anterior vertebral body tethering. Sci Rep 2021; 11:23049. [PMID: 34845240 PMCID: PMC8629973 DOI: 10.1038/s41598-021-02358-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
Fusion is the current standard of care for AIS. Anterior vertebral body tethering (AVBT) is a motion-sparing alternative gaining interest. As a novel procedure, there is a paucity of literature on safety. Here, we report 90-day complication rates in 184 patients who underwent AVBT by a single surgeon. Patients were retrospectively reviewed. Approaches included 71 thoracic, 45 thoracolumbar, 68 double. Major complications were those requiring readmittance or reoperation, prolonged use of invasive materials such as chest tubes, or resulted in spinal cord or nerve root injury. Minor complications resolved without invasive intervention. Mean operative time and blood loss were 186.5 ± 60.3 min and 167.2 ± 105.0 ml, respectively. No patient required allogenic blood transfusion. 6 patients experienced major (3.3%), and 6 had minor complications (3.3%). Major complications included 3 chylothoracies, 2 hemothoracies, and 1 lumbar radiculopathy secondary to screw placement requiring re-operation. Minor complications included 1 patient with respiratory distress requiring supplementary oxygen, 1 superficial wound infection, 2 cases of prolonged nausea, and 1 Raynaud phenomenon. In 184 patients who underwent AVBT for AIS, major and minor complication rates were both 3.3%.
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Iida T, Katayanagi J, Ato A, Matsumoto K, Hayamizu A, Furukawa H, Tobinaga T, Yazawa M, Miyazaki C, Ozeki S. Performance of Forward Roll Maneuvers Following Corrective Spinal Fusion for Idiopathic Scoliosis Patients. Orthop Traumatol Surg Res 2021; 107:103034. [PMID: 34364003 DOI: 10.1016/j.otsr.2021.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fusion surgeries for scoliosis patients are believed to deteriorate sports performance; in particular, forward roll should deteriorate, but no literature is available to substantiate this claim. HYPOTHESIS The extent of postoperative deterioration can vary according to surgery type or curve type. PATIENTS AND METHODS Idiopathic scoliosis patients between 10 and 29 years of age who underwent correction and fusion surgeries at our hospital were included in this study. Forward roll was recorded on video preoperatively and 1-year postoperatively. Performances were evaluated twice on a 10-point scale by two blinded examiners. Preoperative and 1-year postoperative upright spinal radiographs were analyzed for the Lenke classification, number of fused vertebrae, upper and lower instrumented vertebrae, major curve Cobb angle, thoracic kyphosis, lumbar lordosis, and surgical procedures. RESULTS The average age was 16 years. Curve types according to the Lenke classification were: 15, type 1; 5, type 2; 14, type 5; 2, type 6. The mean number of fused vertebrae was 6.9 (3.2 for anterior surgeries and 9.3 for posterior surgeries). The mean preoperative assessment of forward roll was 9.6 points, and the 1-year postoperative assessment was lower at 8.8 points. Cluster analysis classified patients into 3 groups: long fusion with marked performance deterioration (C1), long fusion with minimal deterioration (C2), and short fusion with minimal deterioration (C3). The upper and lower instrumented vertebrae in C1 were more distal than those in C2. CONCLUSION Patients with thoracic curves were classified into two groups, and patients who underwent surgeries with more distal upper and lower instrumented vertebra levels exhibited lower postoperative performance. However, patients with Lenke 5 curves who underwent anterior surgery showed better preoperative performance than other patients who underwent posterior surgery, showing minimal postoperative deterioration. LEVEL OF EVIDENCE III;Therapeutic Study.
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Affiliation(s)
- Takahiro Iida
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan.
| | - Jyunya Katayanagi
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan
| | - Akihisa Ato
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan
| | - Kazuyuki Matsumoto
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan
| | - Atsuki Hayamizu
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan
| | - Hirokazu Furukawa
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan
| | - Takashi Tobinaga
- Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Makoto Yazawa
- Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Chieko Miyazaki
- Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Satoru Ozeki
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, 343-8555 Saitama, Japan
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Ho D, Du JY, Erkilinc M, Glotzbecker MP, Mistovich RJ. Getting Them Back in the Game: When Can Athletes With Adolescent Idiopathic Scoliosis Safely Return to Sports? A Mixed-effects Study of the Pediatric Orthopaedic Association of North America. J Pediatr Orthop 2021; 41:e717-e721. [PMID: 34267153 DOI: 10.1097/bpo.0000000000001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the relative frequency of posterior spinal fusion (PSF) and instrumentation for adolescent idiopathic scoliosis (AIS), there are limited guidelines for postoperative return to sports. Few studies explore factors influencing treating surgeons' recommendations. METHODS A survey presenting several clinical vignettes of patients who had undergone PSF for AIS was distributed to 1496 Pediatric Orthopaedic Society of North America (POSNA) members. Of the 257 returned surveys, 170 met the inclusion criteria. Mixed-effects models were created to assess the effects of the surgeon and hypothetical patient characteristics on return to jogging, noncontact, contact, and collision sports. RESULTS Estimated marginal mean time to return to sporting activities increased for more physically demanding sports [jogging: 4.1 mo, 95% confidence interval (CI): 3.8-4.3; noncontact: 4.6 mo, 95% CI: 4.3-4.9; contact: 6.8 mo, 95% CI: 6.4-7.1; collision: 9.8 mo, 95% CI: 9.2-10.4]. Hypothetical patient characteristics (sex, age, obesity, skeletal maturity, levels fused, and fusions ending in thoracic versus lumbar spine) were not associated with changes in return to sport recommendations for jogging, noncontact, contact, or collision activities. Surgeon volume, experience, fellowship type, and practice setting all affected return to all activities (P<0.05). Surgeons with prior complications from return to sport delayed return to collision activities (9.4 mo, 95% CI: 8.4-10.3) versus surgeons without complications (7.2 mo, 95% CI: 5.7-8.7, P<0.001). CONCLUSIONS Surgeons currently allow earlier return to high-intensity sports after PSF for AIS compared with previous studies. Protocol trends vary based on physician-related factors such as years in practice, case volume, fellowship training, practice type, and prior experience with complications. Patient-related factors were not found to impact return to sport protocols. This survey provides a portrait of current practice trends and serves as a foundation for future investigation. LEVEL OF EVIDENCE Level V-survey study.
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Affiliation(s)
- Dedi Ho
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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16
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Bachmann KR. Spinal Deformities in the Adolescent Athlete. Clin Sports Med 2021; 40:541-554. [PMID: 34051945 DOI: 10.1016/j.csm.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Idiopathic scoliosis will be noted in 2% to 3% of typically developing athletes. Sports physicals are an opportunity to screen for spinal deformity and to promote healthy involvement in activities. Bracing is effective at limiting further progression if a curve progresses beyond 20°. If spinal fusion is performed, most surgeons allow return to noncontact and contact sports by 6 to 12 months. There are many other conditions associated with scoliosis that require a more nuanced approach and assessment of the entire patient. Patients with Down syndrome should be examined for myelopathy before participation and a lateral radiograph obtained if concerned for instability.
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Affiliation(s)
- Keith R Bachmann
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA.
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17
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Willson LR, Klootwyk M, Rogers LG, Shearer K, Southon S, Sasseville C. Timelines for returning to physical activity following pediatric spinal surgery: recommendations from the literature and preliminary data. BMC Res Notes 2021; 14:159. [PMID: 33926530 PMCID: PMC8082610 DOI: 10.1186/s13104-021-05571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/15/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Participation in physical activity and sports is known to have positive implications for physical health, and for social and emotional wellbeing of children. Following corrective spinal surgery for scoliosis, the timeline for the return to activities and sports varies from surgeon to surgeon and from location to location, and return to activities can be limited due to pain, fear, and decreased flexibility. It is critical that patients know best-practice guidelines, and it is equally critical that medical professionals know whether their patients are following those guidelines. This paper includes a summary of recommendations published in the literature, and a pilot study to address a gap in the literature on determining how long, post-surgery, adolescents with idiopathic scoliosis waited before returning to various self-care and physical activities, and what factors influenced return to activities. We used a mixed-method approach that involved two phases: a questionnaire (n = 8), and subsequent interviews of some participants (n = 3). Participants were ages 14–17 (M = 15.4) and had had posterior instrumentation and fusion for scoliosis in the past 2 years. Results Some patients were cautious about return to activities, either because of emotional or medical reasons. However, in many instances, participants returned to physical activities earlier than was recommended, primarily for emotional and social reasons. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05571-2.
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Affiliation(s)
- Leanne R Willson
- The King's University, 9125-50 Street NW, Edmonton, AB, T6B 2H3, Canada.
| | - Madeline Klootwyk
- The King's University, 9125-50 Street NW, Edmonton, AB, T6B 2H3, Canada
| | - Laura G Rogers
- The King's University, 9125-50 Street NW, Edmonton, AB, T6B 2H3, Canada
| | - Kathleen Shearer
- Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Sarah Southon
- Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.,University of Alberta, Faculty of Nursing 4-141 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada
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Impact of Spinal Deformity Characteristics on Patient-reported Outcome Measurement Information System Scores in Patients With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00009. [PMID: 33735148 DOI: 10.5435/jaaosglobal-d-21-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The impact of posterior spinal fusion (PSF) on physical function and pain and mental health in pediatric patients as quantified by the Patient-Reported Outcomes Measurement Information System (PROMIS), developed by the National Institute of Health, is largely unknown. The purpose of this study is to report the changes of PROMIS scores for upper extremity (UE), pain interference (PI), mobility (MOB), and peer relationships (PR) after PSF in patients with idiopathic scoliosis (IS), compare postoperative changes in PROMIS PI and Scoliosis Research Society-30 pain scores, and evaluate associations between curve characteristics and PROMIS scores. METHODS A retrospective cohort of 122 patients (<18 years old) who underwent PSF for IS was identified through electronic medical record search. PROMIS scores were obtained preoperatively and 6 weeks, 6 months, 1 years, 2 years, and 3 years postoperatively. RESULTS The mean age of the cohort was 14.2 ± 1.6 years, and the mean Cobb angle was 62.9 ± 13.8° at surgery. Eighty patients had preoperative PROMIS data. UE and MOB scores were statistically lower at 6 weeks and 6 months postoperatively and returned to baseline with a longer follow-up. PI scores were significantly lower at 1 and 2 years postoperatively. PR was unchanged up to 2 years postoperatively and then showed significant improvement. There was a statistically significant negative relationships between lowest instrumented vertebra and PROMIS UE and MOB scores at 6 weeks and 1 year postoperatively, but not at a longer follow-up. There were no significant differences noted in PI and PR PROMIS scores and lowest instrumented vertebra. PROMIS scores were not statistically associated with the Lenke Classification, number of vertebral levels fused, or percentage coronal correction. DISCUSSION Changes in PROMIS functional domains (UE and MOB) postoperatively normalize at longer follow-ups. Changes in PI and PR demonstrated improvements over preoperative values at 1 to 2 years postoperatively. Preoperative coronal and sagittal measures, and the percentage correction did not correlate with any PROMIS scores.
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Barile F, Ruffilli A, Manzetti M, Fiore M, Panciera A, Viroli G, Faldini C. Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: a review of the current literature. Spine Deform 2021; 9:1247-1251. [PMID: 33759111 PMCID: PMC8363544 DOI: 10.1007/s43390-021-00330-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a frequent disorder. Since patients with AIS are typically as active as age-matched controls and post-operative reduction in physical activity has detrimental effects on their well-being, return to sport (RTS) is an important perioperative concern. Aim of the present study is to review the literature concerning return to sport after spinal fusion for AIS. METHODS This work was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out in December 2020. Only peer-reviewed randomized controlled trials (RCTs), retrospective studies (RS), retrospective case series (RCS) and perspective cohort studies (PCS) were considered for inclusion. RESULTS Six studies were included; only one of them was prospective. All the authors reported a time to RTS ranging between 6 and 18 months. Between 28 and 36.6% of all patients changed sport, choosing lower impact activities, mostly due to loss of flexibility of the spine. No complications due to return to play were noted. CONCLUSION According to current evidence, patients who received spinal arthrodesis for AIS can safely return to any sport, even those that require extreme levels of spinal and pelvic movements such as gymnastics and golf. As there is little evidence, however, of the spinal loading that occurs during such movements, there is a lack of scientific evidence-based recommendations or guidelines surgeons and other health care providers can follow. Prospective comparative studies are needed to investigate these biomechanical and clinical issues. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Francesca Barile
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Michele Fiore
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alessandro Panciera
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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20
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Abstract
Adult spinal deformity causes significant health-related problems such as pain and disability in adults. Currently, there are several non-operative management strategies such as pain medications, physical modalities, exercises, bracing or interventional procedures. Specific exercises including strengthening of back and abdominal muscles, neuromuscular re-education for daily tasks, and active self-correction are vital to improve postural control and spinal stability. Bracing for a few hours a day can help reduce pain and provide spinal stability in adults. In case of severe disability and pain unresponsive to non-operative treatments, spinal fusion with instrumentation is an alternative. Postoperative rehabilitation can help to reduce pain and disability and improve return to activity or work. Protecting the spine early after surgery and timing of initiation of exercises with respect to osseointegration and bone remodeling phases are important principles of postoperative rehabilitation. In this review, rehabilitation in adult spinal deformity is discussed in the light of the literature.
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21
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Mimura T, Ikegami S, Kuraishi S, Uehara M, Oba H, Takizawa T, Munakata R, Hatakenaka T, Koseki M, Takahashi J. Residual thoracolumbar/lumbar curve is related to self-image after posterior spinal fusion for Lenke 1 and 2 curves in adolescent idiopathic scoliosis patients. J Neurosurg Pediatr 2020; 26:211-216. [PMID: 32330894 DOI: 10.3171/2020.2.peds19656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although it is well known that major curve severity in adolescent idiopathic scoliosis (AIS) is inversely related to self-image, surgeons often encounter patients who complain of low self-image with preoperatively mild curves or postoperatively well-corrected main curves, suggesting the presence of other factors. This study examined factors contributing to self-image in AIS. METHODS A total of 86 consecutive patients who underwent posterior spinal fusion for AIS Lenke 1 or 2 curves and were followed for a minimum of 2 years were included in this study of patient self-image based on data that included scores reported on the Scoliosis Research Society survey (SRS-22r). The authors evaluated sex, BMI, Risser grade, age, angle of trunk rotation, Cobb angle of the main thoracic (MT) curve, Cobb angle of the thoracolumbar/lumbar (TL/L) curve, apical vertebral translation (AVT), T5-12 kyphotic angle, and clavicular angle. Univariate and multivariate general linear models were employed to identify preoperative and 2-year postoperative factors that impact self-image. RESULTS Univariate analysis revealed no significant correlation between preoperative MT curve Cobb angle and SRS-22r self-image score (p = 0.51), although patients with a higher MT curve AVT had a significantly worse preoperative self-image (p < 0.01). Two years postoperatively, larger Cobb angle of the TL/L curve (p = 0.01) and higher Risser grade (p = 0.03) resulted in significantly lower self-image scores. In multivariate testing, preoperative MT curve AVT remained significantly related to diminished self-image (p < 0.01). Two years later, higher TL/L curve (p < 0.01), Risser grade (p = 0.03), and MT curve AVT (p = 0.03) had significant associations with lower self-image scores. CONCLUSIONS Preoperative MT curve AVT appears more strongly related to self-image than does Cobb angle. Two years postoperatively, persistent TL/L region curvature and high Risser grade may also be associated with diminished patient self-image.
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Affiliation(s)
- Tetsuhiko Mimura
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Shota Ikegami
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Shugo Kuraishi
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Masashi Uehara
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Hiroki Oba
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Takashi Takizawa
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Ryo Munakata
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Terue Hatakenaka
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
| | - Michihiko Koseki
- 2Faculty of Textile Science and Technology, Shinshu University, Ueda, Nagano, Japan
| | - Jun Takahashi
- 1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
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Sellyn GE, Hale AT, Tang AR, Waters A, Shannon CN, Bonfield CM. Pediatric thoracolumbar spine surgery and return to athletics: a systematic review. J Neurosurg Pediatr 2019; 24:702-712. [PMID: 31561230 DOI: 10.3171/2019.7.peds19290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal conditions and injuries in the pediatric population can necessitate surgical treatment. For many pediatric patients, a return to athletic activity after spinal surgery is a significant postoperative focus. However, there is a lack of standardized guidelines to determine criteria for safe return to play (RTP). To understand clinical criteria for patients to safely RTP, the authors conducted a systematic review of outcomes and the period of time before physicians recommend an RTP for pediatric patients undergoing spinal surgery. METHODS English-language publications were searched systematically in the PubMed electronic database, and a review was conducted in accordance with the PRISMA guidelines. Additional relevant studies found via a supplementary literature search were also included. Studies assessing return to athletic activity in a pediatric population after spinal surgery were included. Studies without an RTP, postsurgical activity outcomes, or surgical intervention were excluded. RESULTS A PubMed search identified 295 articles, with 29 included for the systematic review. In addition, 4 studies were included from a supplementary literature search. The majority of these studies were retrospective case series and cohort studies, and the remaining studies included questionnaire-based studies, prospective cohorts, and case-control studies. The most common spinal conditions or injuries included spondylolysis, and this was followed by adolescent idiopathic scoliosis. Overall, the most frequent recommendation for RTP for noncontact and contact sports was 6 months after surgery (range 1-12 months), and for collision sports it was 12 months after surgery. However, some physicians recommended never returning to collision sports after spinal intervention. CONCLUSIONS Most pediatric patients are able to return to some level of sports after spinal surgery. However, no standardized criteria have been proposed, and RTP recommendations vary according to the treating surgeon. In addition, limited data are published on the variation in timelines for RTP with regard to classifications of sports (noncontact, contact, and collision). Further analysis of specific spinal conditions and injuries with postoperative athletic recovery is needed.
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Affiliation(s)
- Georgina E Sellyn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew T Hale
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 2Vanderbilt University School of Medicine; and
| | - Alan R Tang
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 2Vanderbilt University School of Medicine; and
| | - Alaina Waters
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Spine and Lower Extremity Kinematics Exhibited During Running by Adolescent Idiopathic Scoliosis Patients With Spinal Fusion. Spine Deform 2019; 7:254-261. [PMID: 30660219 DOI: 10.1016/j.jspd.2018.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022]
Abstract
STUDY DESIGN Case-controlled design; biomechanics laboratory setting. OBJECTIVE To compare the spine and lower extremity kinematics displayed during high-effort running between individuals with spinal fusion surgery for adolescent idiopathic scoliosis (SF-AIS) and healthy controls (CON). SUMMARY OF BACKGROUND DATA Individuals with SF-AIS often return to exercise and sports that include running. However, how these individuals produce the spinal rotations needed during high-effort running and thus compensate for the loss of spinal flexibility is not known. METHODS Ten SF-AIS (posterior-approach spinal fusion; postoperative time: 2.0 ± 0.6 years; physically active) and 10 CON individuals, pair-matched for gender, age, mass, height, and level of physical activity participated. SF-AIS individuals ran on a treadmill at a self-selected submaximal speed perceived as "hard" (15/20 on Borg perceived-effort scale), and CON ran at the SF-AIS pair-matched speed. 3D motion capture system was used to generate trunk and pelvis segmental angles (trunk segments = upper trunk [C7-T8], middle trunk [T9-T12], lower trunk [L1-L5]), relative angles (relative angles between the two consecutive trunk segments), and lower extremity joint angles. The group differences between the SF-AIS and CON were assessed using one-way analysis of covariance (with running speed as the covariate) for trunk, lower extremity, and step kinematics. RESULTS SF-AIS participants exhibited a significantly greater (6.1° greater) lower trunk and (6.3° greater) pelvis segmental axial rotation compared with CON during running. In addition, SF-AIS participants displayed a 9.2° less ankle plantarflexion during the support phase. There were no significant differences detected for step kinematics. CONCLUSION Possibly because of relearned compensatory mechanism, individuals with SF-AIS displayed similar patterns of spine, lower extremity, and step kinematics as healthy controls during high-effort running with some exceptions. LEVEL OF EVIDENCE Level III.
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Holewijn RM, Kingma I, de Kleuver M, Keijsers NLW. Posterior spinal surgery for adolescent idiopathic scoliosis does not induce compensatory increases in distal adjacent segment motion: a prospective gait analysis study. Spine J 2018; 18:2213-2219. [PMID: 29746962 DOI: 10.1016/j.spinee.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/17/2018] [Accepted: 05/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with adolescent idiopathic scoliosis (AIS) perform surprisingly well after spinal correction and fusion. It was previously hypothesized that, during gait, certain mechanisms compensate for the loss in spinal motion. Still, previous studies could not identify such compensatory mechanisms in the lower body. PURPOSE This study aims to test the hypothesis of a compensatory increased motion of the distal unfused part of the spine during gait after posterior spinal correction and fusion. STUDY This is a prospective gait study. PATIENTS AND METHODS Twelve patients with AIS were included. Sets of three VICON skin markers were used to measure the 3D motion of the proximal part of the fusion in relation to the pelvis (PFP) and the distal part of the fusion in relation to the pelvis (DFP). By doing so, PFP represents the motion of the fused and unfused parts of the spine, and DFP represents the motion of the unfused part of the spine. Measurements were performed preoperatively and 3 and 12 months after posterior spinal correction and fusion. RESULTS Surgery resulted in a decrease in PFP transversal plane range of motion (ROM) (8.3° vs. 5.9°, p=.006). No compensatory increase in the ROM of DFP could be identified. Actually, DFP transversal plane ROM also decreased (8.2° vs. 5.6°, p=.019). No improvement over time was observed when comparing the 3- and 12-month postoperative measurements. CONCLUSIONS The hypothesis of a compensatory increase in motion of the distal unfused segments after spinal fusion for AIS is a much researched and controversial topic. This study is the first to study this hypothesis in such detail during gait and could not demonstrate such increase.
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Affiliation(s)
- Roderick M Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
| | - Idsart Kingma
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, De Boelelaan 1105, Amsterdam, 1081 HV, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopedic Surgery, Radboud University Medical Center, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Sint Maartenskliniek Research, Sint Maartenskliniek, Mailbox 9011, 6500 GM, Ubbergen, The Netherlands
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25
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When Do Patients Return to Physical Activities and Athletics After Scoliosis Surgery?: A Validated Patient Questionnaire Based Study. Spine (Phila Pa 1976) 2018; 43:167-171. [PMID: 28604495 DOI: 10.1097/brs.0000000000002284] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective chart review with a survey. OBJECTIVES This study seeks to determine time of return to normal, physical and athletic activities, and delaying factors after all pedicle screw fixation. SUMMARY OF BACKGROUND DATA Return to athletic activity after posterior spine fusion (PSF) in adolescent idiopathic scoliosis (AIS) is largely dependent on a surgeon's philosophy. Some allow contact and collision sports by 6 and 12 months, while others avoid contact sports for 1 year and never allow collision sports. We have utilized a patient driven self-directed approach. METHODS The sports activity questionnaire (SAQ) was developed and activities were categorized into normal (school, gym, and backpack), physical (running, bending, and bicycling) and athletics (AAP criteria: noncontact, contact and collision sports). SAQ was validated through the "test-retest" method on 25 patients and retesting after 3 weeks to minimize recall bias. Questions with kappa >0.7 were included. Patient demographics, x-ray measurements, and perioperative details were recorded. RESULTS Ninety five patients completed the SAQ. By 3 months; 77% (72/93) returned to school, 60% (54/90) to bending, 52% (48/93) to carrying backpacks, 43% (37/87) to running, and 37% (30/81) to gym. By 6 months, 54% (27/50) returned to noncontact sports, and 63% (21/33) to contact sports. 79% and 53% returned to preoperative level of contact and noncontact sports, respectively. Higher body mass index (BMI) was a risk for delayed return (>3 mo) to school and gym (P < 0.05), while fusion below L2 and younger age for running, bending, and carrying backpacks (P < 0.05). In contrast, there was no patient/curve characteristics associated with a delay to sports. Lowest instrumented vertebra (LIV), Lenke types were not risk factors. There was no correction loss, implant failure, or complications. CONCLUSION Patients return to athletics much earlier than expected; a quarter returned by 3 months, and over half by 6 months. Age and LIV are determinants for return to "physical activity." LEVEL OF EVIDENCE 3.
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26
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Kakar RS, Li Y, Brown CN, Kim SH, Oswald TS, Simpson KJ. Spine kinematics exhibited during the stop-jump by physically active individuals with adolescent idiopathic scoliosis and spinal fusion. Spine J 2018; 18:155-163. [PMID: 28964824 DOI: 10.1016/j.spinee.2017.08.221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/16/2017] [Accepted: 08/08/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Individuals with adolescent idiopathic scoliosis post spinal fusion often return to exercise and sport. However, the movements that individuals with spinal fusion for adolescent idiopathic scoliosis (SF-AIS) use to compensate for the loss of spinal flexibility during high-effort tasks are not known. PURPOSE The objective of this study was to compare the spinal kinematics of the trunk segments displayed during the stop-jump, a maximal effort task, between SF-AIS and healthy control groups. STUDY DESIGN The study used a case-controlled design. MATERIALS AND METHODS Ten SF-AIS (physically active, posterior-approach spinal fusion: 11.2±1.9 fused segments, postop time: 2±.6 years) and nine control individuals, pair matched for gender, age (17.4±1.3 years and 20.6±1.5 years, respectively), mass (63.50±12.2 kg and 66. 40±10.9 kg), height (1.69±.09 m and 1.72±.08 m), and level of physical activity, participated in the study. Individuals with spinal fusion for adolescent idiopathic scoliosis and controls (CON) performed five acceptable trials of the stop-jump task. Spatial locations of 21 retroreflective trunk and pelvis markers were recorded via high-speed motion capture methodology. Mean differences and analysis of covariance (jump height=covariate, p<.05) were used to compare the groups' relative angle (RelAng) and segmental angle (SegAng) of the three trunk segments (trunk segments=upper trunk [C7-T8], middle trunk [MT: T9-T12], lower trunk [LT: L1-L5]) for each rotation plane in the three phases of interest (flight, stance, and the vertical flight phases). RESULTS No significant group differences for jump height and RelAng were detected in the three phases of stop-jump. Individuals with spinal fusion for adolescent idiopathic scoliosis displayed 3.2° greater transverse plane RelAng of LT compared with CON (p=.059) in the stance phase. Group differences for RelAng ranged from 0° to 15.3°. For SegAng in the stance phase, LT demonstrated greater SegAng in the sagittal and frontal planes (mean difference: 3.2°-6.2°), whereas SegAng for MT was 5.1° greater in the sagittal plane and had a tendency of 2° greater displacement in the frontal plane (p=.070). In the vertical flight phase, greater LT displacement in the frontal plane was observed for SF-AIS than CON. In the flight phase, LT had a tendency for greater SegAng for SF-AIS than for CON in the transverse plane (p=.089). CONCLUSIONS Overall, SF-AIS who participate in physical activity on a regular basis are able to demonstrate similar trunk kinematics during a high-intensity stop-jump task as their matched healthy peers. Fewer group differences for relative angular displacements of the spine were observed than anticipated. This finding suggests that the fused MT appeared to be moving synchronously with the LT, thereby suggesting a compensatory adaptation of SF-AIS to achieve sufficient trunk movements during this high-effort movement.
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Affiliation(s)
- Rumit Singh Kakar
- Department of Physical Therapy, Ithaca College, 953 Danby Rd, Ithaca, New York, NY, USA.
| | - Yumeng Li
- Department of Kinesiology, California State University, Chico, Yolo 243, Chico, CA, USA
| | - Cathleen N Brown
- Athletic Training and Kinesiology, Oregon State University Corvallis, 160 SW 26th St, Corvallis, OR, USA
| | - Seock-Ho Kim
- Department of Educational Psychology, University of Georgia, 630 Aderhold Rd, Athens, GA, USA
| | - Timothy S Oswald
- Department of Pediatric Orthopedics, Pediatric Orthopaedic Associates, 6 Executive Park Drive, Atlanta, GA, USA
| | - Kathy J Simpson
- Department of Kinesiology, University of Georgia, 330 River Rd, Athens, GA, USA
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Pain is the Greatest Preoperative Concern for Patients and Parents Before Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2017; 42:E1245-E1250. [PMID: 28263228 DOI: 10.1097/brs.0000000000002147] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional study. OBJECTIVE To evaluate patients' and parents' concerns so they can be addressed with appropriate preoperative counseling. SUMMARY OF BACKGROUND DATA Despite much research on outcomes for posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS), little is available about preoperative fears or concerns. METHODS Patients with AIS undergoing PSF, their parents, and surgeons were prospectively enrolled and asked to complete a survey on their fears and concerns about surgery at their preoperative appointment. RESULTS Forty-eight patients and parents completed surveys. Four attending pediatric spine surgeons participated and submitted 48 responses. Mean age of patients was 14.2 years. On a scale of 0 to 10, mean level of concern reported by parents (6.9) was higher than that reported by patients (4.6). Surgeons rated the procedure's complexity on a scale of 0 to 10 and reported a mean of 5.2. Neither patients' nor parents' level of concern correlated with the surgeons' assessment of the procedure's complexity level (R = 0.19 and 0.12, P = 0.20 and P = 0.42, respectively). Top three concerns for patients were pain (25%), ability to return to activities (21%), and neurologic injury (17%). Top three concerns for parents were pain (35%), neurologic injury (21%), and amount of correction (17%). Top three concerns for surgeons were postoperative shoulder balance (44%), neurologic injury (27%), and lowest instrumented vertebrae selection (27%). Patients reported the same concerns 23% of the time as parents, and 17% of the time as surgeons. Parents and surgeons reported the same concerns 21% of the time. CONCLUSION Pain was the greatest concern for both patients and parents but was rarely listed as a concern by surgeons. Parent and patient level of concern did not correlate to the surgeon's assessment of the procedure's complexity. Neurologic injury was a top concern for all groups, but otherwise there was little overlap between physician, patient, and parent concerns. LEVEL OF EVIDENCE 3.
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28
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A Silver Medal Winner at the 13th World Wu Shu Championship 2015 17 Months After Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis: A Case Report. Spine (Phila Pa 1976) 2017; 42:E248-E252. [PMID: 28207671 DOI: 10.1097/brs.0000000000001748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report the successful rehabilitation and the training progress of an elite high performance martial art exponent after selective thoracic fusion for Adolescent Idiopathic Scoliosis (AIS). SUMMARY OF BACKGROUND DATA Posterior spinal fusion for AIS will result in loss of spinal flexibility. The process of rehabilitation after posterior spinal fusion for AIS remains controversial and there are few reports of return to elite sports performance after posterior spinal fusion for AIS. METHODS We report a case of a 25-year-old lady who was a national Wu Shu exponent. She was a Taolu (Exhibition) exponent. She underwent Selective Thoracic Fusion (T4 to T12) using alternate level pedicle screw placement augmented with autogenous local bone graft in June 2014. She commenced her training at 3-month postsurgery and the intensity of her training was increased after 6 months postsurgery. We followed her up to 2 years postsurgery and showed no instrumentation failure or lost of correction. RESULTS After selective thoracic fusion, her training process consisted of mainly speed training, core strengthening, limb strengthening, and flexibility exercises. At 17 months of postoperation, she participated in 13th World Wu Shu Championship 2015 and won the silver medal. CONCLUSION Return to elite high-performance martial arts sports was possible after selective thoracic fusion for AIS. The accelerated and intensive training regime did not lead to any instrumentation failure and complications. LEVEL OF EVIDENCE 2.
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29
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Abstract
CONTEXT Pediatric patients who undergo spinal surgery are frequently involved in sporting activities. Return to play is often an important postoperative concern for the patient and family. EVIDENCE ACQUISITION A PubMed search was conducted for articles in the English language on return to play after treatment of pediatric acute disc herniation, degenerative disc disease, spondylolysis, spondylolisthesis, and scoliosis from 1980 to 2015. Reference lists were reviewed for additional pertinent articles. We included articles that focused on return to sports after surgical treatment of these conditions in this review. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS There are no published guidelines, and most of the literature in this area has focused on return to play after spinal injury rather than after spinal surgery. Most children and adolescents have excellent outcomes with minimal pain at 1 year after lumbar discectomy. The majority of surgeons allow return to full activity once pain-free range of motion and strength are regained, typically at 8 to 12 weeks postoperatively. Pediatric patients with spondylolysis have good outcomes after direct pars repair. Satisfactory outcomes have been demonstrated after fusion for low- and high-grade spondylolisthesis. Most surgeons allow return to noncontact sports by 6 months after surgical treatment of spondylolysis and spondylolisthesis. Return to contact and collision sports is controversial. After posterior spinal fusion for scoliosis, most surgeons allow return to noncontact sports by 3 months and return to contact sports between 6 months and 1 year. Return to collision sports is controversial. CONCLUSION There is little evidence to guide practitioners on return to sports after pediatric spinal surgery. Ultimately, the decision to allow any young athlete to resume sports participation after spinal injury or surgery must be individualized.
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Affiliation(s)
- Tyler Christman
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Ying Li
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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