1
|
Byvaltsev VA, Kalinin AA, Aliyev MA, Pestryakov YY, Riew KD. Long-term results and surgical strategy development for degenerative disease treatment in athletes: a retrospective single-center study. 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 2024:10.1007/s00586-024-08283-w. [PMID: 38874639 DOI: 10.1007/s00586-024-08283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To analyze of the results of spine surgical treatment of athletes with lumbar degenerative disease and development of a surgical strategy based on the preoperative symptoms and radiological changes in the lumbar spine. METHODS For 114 athletes with lumbar degenerative disease were included in the present study. Four independent groups were studied: (1) microsurgical/endoscopic discectomy (n = 35); (2) PRP therapy in facet joints (n = 41); (3) total disc replacement (n = 11); (4) lumbar interbody fusion (n = 27). We evaluated postoperative clinical outcomes and preoperative radiological results. The average postoperative follow-up was 5 (3;6), 3.5 (3;5), 3 (2;4) and 4 (3;5) years, respectively. The analysis included an assessment of clinical outcomes (initial clinical symptoms, chronic pain syndrome level according to the VAS, quality of life according to the SF-36 questionnaire, degree of tolerance to physical activity according to the subjective Borg Rating of Perceived Exertion Scale) and radiological data (Dynamic Slip, Dynamic Segmental Angle, degenerative changes in the facet joint according to the Fujiwara classification and disc according to the Pfirrmann classification; changes in the diffusion coefficient using diffusion-weighted MRI). RESULTS The median and 25-75% quartiles timing of return to sports were 12.6 (10.2;14.1), 2.8 (2.4;3.7), 9 (6;12), and 14 (9;17) weeks, respectively. We examined the type of surgical treatment utilized, as well as the preoperative clinical symptoms, severity of degenerative changes in the intervertebral disc and facet joint, the timing of return to sports, the level of pain syndrome, the quality of life according to SF-36, and the degree of tolerance to physical activity. We then developed a surgical strategy based on individual preoperative neurological function and lumbar morphological changes. CONCLUSIONS In this retrospective study, we report clinical results of four treatment options of lumbar spine degenerative disease in athletes. The use of developed patient selection criteria for the analyzed surgical techniques is aimed at minimizing return-to-play times.
Collapse
Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Marat A Aliyev
- Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Yurii Ya Pestryakov
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York, USA
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Goto K, Kawasaki Y, Hirota J, Yamamoto N, Seichi A. Return-to-Sport Rate, Type of Sport, Frequency of Participation, and Patient Satisfaction After Elective Spinal Surgery in the Elderly Population. Orthop J Sports Med 2023; 11:23259671231169936. [PMID: 37223071 PMCID: PMC10201160 DOI: 10.1177/23259671231169936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 05/25/2023] Open
Abstract
Background The number of elderly sports participants is increasing, and the possibility of return to sport (RTS) has become an important part of surgical decision making in this population. Purpose To investigate RTS after elective spinal surgery in elderly patients. Study Design Case series; Level of evidence, 4. Methods We enrolled patients aged ≥65 years with a history of preoperative or preinjury sports participation who underwent elective spinal surgery at a single institution between 2019 and 2021. At minimum 12-month follow-up, a questionnaire was administered to each participant to assess postoperative RTS, timing of return, frequency and type of pre- and postoperative activities, and satisfaction (scored 1-10). Descriptive statistical analyses were performed, and regression models were developed to examine the influence of age and sex, as well as surgical site, on RTS. Results A total of 53 patients (mean ± SD age, 73.8 ± 5.2 years; 24 women) were included, and 23 (43.4%) returned to sports at a median 6 months (interquartile range, IQR, 2-6 months). The RTS rate by surgical site was 17 of 34 (50%) for the lumbar spine and 6 of 17 (35.3%) for the cervical spine. There were no statistically significant differences in RTS rate by surgical site, age, or sex. Overall, 6 of 17 patients returned to golf, 4 of 6 to dance, 2 of 5 to swimming, and 1 of 5 to tennis. Of patients who returned, 34.8% participated in sports 5 times per week and 26.1% participated 3 times per week. The median satisfaction score after RTS was 8 (IQR, 6-9). Conclusion RTS after spinal surgery was achieved in 43% patients at 1-year minimum follow-up, with high satisfaction scores. More than half of the returning patients participated in sports activities ≥3 times per week.
Collapse
Affiliation(s)
- Kazumi Goto
- Department of Orthopaedic Surgery,
Mitsui Memorial Hospital, Tokyo, Japan
| | - Yosuke Kawasaki
- Department of Orthopaedic Surgery,
Mitsui Memorial Hospital, Tokyo, Japan
| | - Jinso Hirota
- Department of Orthopaedic Surgery,
Mitsui Memorial Hospital, Tokyo, Japan
| | - Naoya Yamamoto
- Department of Orthopaedic Surgery,
Mitsui Memorial Hospital, Tokyo, Japan
| | - Atsushi Seichi
- Department of Orthopaedic Surgery,
Mitsui Memorial Hospital, Tokyo, Japan
| |
Collapse
|
4
|
Kawanishi M, Tanaka H, Ito Y, Yokoyama K, Yamada M. Vertebral Fracture in an Elderly Golfer. Cureus 2022; 14:e27463. [PMID: 36060326 PMCID: PMC9420558 DOI: 10.7759/cureus.27463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/22/2022] Open
Abstract
Golf is one of the most popular sports among seniors. Here, we report the case of a 76-year-old woman who developed a vertebral fracture while playing golf. The patient had been suffering from leg pain for several years but developed sudden back pain after her golf swing. Because magnetic resonance imaging demonstrated a new vertebral fracture of the L1 vertebral body and canal stenosis at the L4/5 level, she successfully underwent L1 vertebroplasty and L4/5 decompression. For older golfers, a classical swing that twists the pelvis and shoulders at the same time may be recommended.
Collapse
|
5
|
Haddas R, Pipkin W, Hellman D, Voronov L, Kwon YH, Guyer R. Is Golf a Contact Sport? Protection of the Spine and Return to Play After Lumbar Surgery. Global Spine J 2022; 12:298-307. [PMID: 33541112 PMCID: PMC8907648 DOI: 10.1177/2192568220983291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To address the gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing. METHODS This review did not involve patient care or any clinical prospective or retrospective review of patient information and thus did not warrant institutional review board approval. The available literature of PubMed, Medline, and OVID was utilized to review the existing literature. RESULTS Studies have shown that the forces through the lumbar spine in the modern-era golf swing are like other contact sports. Methods of protecting the lumbar spine include proper swing mechanics, abdominal and paraspinal musculature strengthening and flexibility as well as physical fitness. There are a variety of treatment options available to treat lumbar spine pathology each with a different return to play recommendations from doctors in the field. CONCLUSIONS With the introduction of a high impact, modern-era swing to the game of golf, the pathology is seen in the lumbar spine of both young, old, professional, and amateur golfers with low back pain are similar to other athletes in contact sports. Surgery is effective in returning athletes to a similar level of play even though no protocols exist for an effective and safe return. There have been many studies conducted to determine appropriate treatment and return to play for these injuries, but there is a gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing. As return to competitive play is important, especially with professional golfers, studies combining the use of swing mechanics changes, rehabilitation regimens and the type of surgery performed would be able to provide some insight into this topic now that golf may begin to be considered a contact sport.
Collapse
Affiliation(s)
- Ram Haddas
- Texas Back Institute, Plano, TX,
USA,Ram Haddas, Texas Back Institute, 6020 West
Parker Road, Plano, TX 75093, USA.
| | - William Pipkin
- UNT Health Science Center & John
Peter Smith Hospital, Fort Worth, TX, USA
| | | | | | | | | |
Collapse
|
6
|
Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Satardinova EE, Biryuchkov MY. [Results of the study of functional recovery of professional athletes after minimally invasive lumbar fusion]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:49-54. [PMID: 34932285 DOI: 10.17116/jnevro202112111149] [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: 11/17/2022]
Abstract
OBJECTIVE To conduct a comprehensive clinical-neurological assessment and to study the results of functional recovery of professional athletes after minimally invasive lumbar interbody fusion. MATERIALS AND METHODS The retrospective study included 27 patients-professional athletes who were operated on using minimally invasive decompression and stabilization techniques in the period 2010 to 2019. Clinical-neurological effectiveness was assessed when returning to previous sports activity was 14 (9; 17) weeks and 4 (3; 5) years after surgery. RESULTS The follow-up showed a significant improvement in clinical and neurological parameters: persistent elimination of radicular and muscular-skeletal symptoms, a decrease in the level of pain according to a visual analogue scale in the lumbar spine from 68 (61; 85) mm to 3 (2; 11) mm (p=0.002) and in the lower extremities from 84 (78; 91) mm to 1 (0; 3) mm (p=0.001), change in the physical component of health from 26.18 (23.58; 28.37) to 49.82 (49.03; 53.04) (p=0.002) and the psychological component of health from 27.87 (26.22; 29.29) to 52.18 (49.12; 55.66) (p=0.001), significant improvement in the perception of physical activity according to the Borg RPE Scale from 17 (16; 18) points to 9 (8; 9) (p<0.001). In one case (3.7%), the patient did not return to his previous sports career. CONCLUSION The use of minimally invasive rigid stabilization in the overwhelming majority of professional athletes made it possible in the shortest possible time to achieve regression of neurological symptoms, reduce pain, improve the quality of life, restore the functional state and return to previous sports activities.
Collapse
Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia.,Clinical Hospital «Russian Railways-Medicine», Irkutsk, Russia.,Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia.,Clinical Hospital «Russian Railways-Medicine», Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - E E Satardinova
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - M Yu Biryuchkov
- Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan
| |
Collapse
|
7
|
Luxenburg D, Bondar KJ, Cohen LL, Constantinescu D, Barnhill S, Donnally CJ. Return to Golf Following Cervical and Lumbar Spinal Fusion: A Systematic Review. World Neurosurg 2021; 156:4-10. [PMID: 34438101 DOI: 10.1016/j.wneu.2021.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a paucity of literature about return to play (RTP) for golf protocols following cervical and lumbar fusions. The timing of return to this sport is a common question among patients. The aim of this review was to analyze and report the current protocols for RTP following cervical and lumbar spinal fusion. METHODS A systematic search was conducted using the following databases: MEDLINE, PubMed, Web of Science, Scopus, and Google Scholar. A 3-step, multiauthor screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included peer-reviewed and published prospective, case-control, cohort, case series, or review articles. Studies had to pertain to RTP for golf following instrumented cervical or lumbar spinal fusion to be included. RESULTS Three articles met inclusion criteria: 2 retrospective survey-based cohort studies and 1 survey-based case series study. All studies included a minimum of 1 year of follow-up. Of patients, 71.6% (n = 51) were able to RTP following surgery; 54.3%-80% were able to RTP at a similar or improved level of play as preoperatively. Postoperative pain reduction was noted in 2 articles. CONCLUSIONS Most golfers are able to RTP within 12 months following cervical or lumbar spinal fusion. Patients generally reported decreased lower back pain and leg pain postoperatively. Following cervical or lumbar fusion, many golfers are able to RTP at the same or an increased frequency compared with preoperatively.
Collapse
Affiliation(s)
- Dylan Luxenburg
- Department of Medical Education, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Kevin J Bondar
- Department of Medical Education, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
| | - Lara L Cohen
- Department of Medical Education, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - David Constantinescu
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - Spencer Barnhill
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | | |
Collapse
|
8
|
Effect of Adding Neural Mobilization Versus Myofascial Release to Stabilization Exercises after Lumbar Spine Fusion: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:251-260. [PMID: 32827553 DOI: 10.1016/j.apmr.2020.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To test the effect of adding neural mobilization (NM) versus myofascial release (MFR) to stabilization exercises (SE) on disability, pain, and lumbar range of motion (ROM) in patients with lumbar spine fusion (LSF). DESIGN A single blinded, parallel groups, randomized controlled trial. SETTING Outpatient public and governmental hospital clinics. PARTICIPANTS Patients (N=60) who had undergone LSF were randomly assigned into 3 equal groups. INTERVENTION Group I received NM plus SE, group II received MFR and SE, and group III received SE only. Each group visited the hospital 3 times a week for 4 weeks. MAIN OUTCOME MEASURES Oswestry disability index (ODI), visual analog scale, and back range of motion (BROM) were assessed before starting treatment, immediately after finishing treatment, and 1 month later. RESULTS There were statistically significant differences among the groups regarding the ODI and pain (P<.05) in favor of the study groups, but no statistically significant differences were found among groups regarding the BROM outcome (P>.05). Regarding the within-group effect, statistically significant differences were found in all outcomes after 1 month of treatment, as well as after 1 month of follow-up in each group (P<.05). CONCLUSIONS Patients who received NM or MFR combined with SE demonstrated better improvement, in favor of the NM group, regarding disability and pain than patients who received SE alone after LSF. No differences were found among the groups regarding lumbar ROM.
Collapse
|