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Zhang J, Zhang R, Wang Y, Dang X. Efficacy of epidural steroid injection in the treatment of sciatica secondary to lumbar disc herniation: a systematic review and meta-analysis. Front Neurol 2024; 15:1406504. [PMID: 38841695 PMCID: PMC11150834 DOI: 10.3389/fneur.2024.1406504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Epidural steroid injection for the treatment of sciatica caused by disc herniation is increasingly used worldwide, but its effectiveness remains controversial. The review aiming to analyze the efficacy of epidural steroid injection on sciatica caused by lumbar disc herniation. Randomized controlled trials (RCTs) investigating the use of epidural steroid injections in the management of sciatica induced by lumbar disc herniation were collected from PubMed and other databases from January, 2008 to December, 2023, with epidural steroid injection in the test group and epidural local anesthetic and/or placebo in the control group. Pain relief rate, assessed by numerical rating scale (NRS) and visual analogue scale (VAS) scores, and function recovery, evaluated by Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) scores, were recorded and compared. Meta-analysis was performed by Review Manager. In comparison to the control group, epidural steroid injections have been shown to be effective for providing short- (within 3 months) [MD = 0.44, 95%CI (0.20, 0.68), p = 0.0003] and medium-term (within 6 months) [MD = 0.66, 95%CI (0.09,1.22), p = 0.02] pain relief for sciatica caused by lumbar disc herniation, while its long-term pain-relief effect were limited. However, the administration of epidural steroid injections did not lead to a significant improvement on sciatic nerve function in short- [MD = 0.79, 95%CI = (0.39, 1.98), p = 0.19] and long-term [MD = 0.47, 95% CI = (-0.86, 1.80), p = 0.49] assessed by IOD. Furthermore, the analysis revealed that administering epidural steroid injections resulted in a reduction in opioid usage among patients with lumbar disc herniation [MD = -14.45, 95% CI = (-24.61, -4.29), p = 0.005]. The incidence of epidural steroid injection was low. Epidural steroid injection has demonstrated notable efficacy in relieving sciatica caused by lumbar disc herniation in short to medium-term. Therefore, it is recommended as a viable treatment option for individuals suffering from sciatica.
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Affiliation(s)
- Jianan Zhang
- Zonglian College, Xi’an Jiaotong University, Xi’an, China
| | - Ruimeng Zhang
- Zonglian College, Xi’an Jiaotong University, Xi’an, China
| | - Yue Wang
- Zonglian College, Xi’an Jiaotong University, Xi’an, China
| | - Xiaoqian Dang
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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2
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Dupont MM, Fourman MS, Iyer S, Qureshi SA, Sheha ED, Rhie-Lee J, Dowdell J. Impact of Lumbar Disk Herniation on Performance Outcomes and New Contracts in the National Football League. Clin Spine Surg 2023; 36:E139-E144. [PMID: 36127776 DOI: 10.1097/bsd.0000000000001389] [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] [Received: 01/13/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To determine performance outcomes and the contract-signing ability for the most recent cohort of professional football players treated for lumbar disk herniation (LDH). SUMMARY OF BACKGROUND DATA LDH can have a significant impact on the career of a National Football League (NFL) player. Previous studies have found favorable return to play (RTP) and performance outcomes for players with LDH, but the impact on the ability to sign new contracts (an important surrogate to assess continued success) has not previously been studied. MATERIALS AND METHODS NFL players treated for LDH from 2000 to 2020 were identified from a public records search. Age, position, type of treatment, and RTP measures were collected. Pro Football Focus (PFF) performance grade and contract values were compared before the injury and after treatment. Multivariable logistic regression was used to identify independent risk factors associated with the ability to RTP and sign high-value contracts. RESULTS One hundred one players were treated for an LDH, of which 75 returned to play. Posttreatment performance as measured by PFF was similar to preinjury levels ( P =0.2). However, both total and guaranteed contract values were significantly reduced ( P <0.01). In multivariable analysis, both lower age and higher preinjury PFF grade were independent predictors of RTP and ability to sign a new contract. A preinjury contract that contained a high proportion of guaranteed money was found to be an independent predictor of the ability to sign a contract that was >20% guaranteed. CONCLUSION Although the majority of players were able to RTP at preserved performance levels following LDH treatment, their contract values were significantly reduced. RTP and contract-signing ability were not associated with the type of treatment, but rather baseline factors such as the player's age, performance, and preinjury compensation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Sravisht Iyer
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Evan D Sheha
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | | | - James Dowdell
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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3
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O'Connor SB, Holmberg KJ, Hammarstedt JE, Acosta JR, Monahan K, Sauber RD, Altman DT. Return-to-Play Outcomes of Athletes After Operative and Nonoperative Treatment of Lumbar Disc Herniation. Curr Rev Musculoskelet Med 2023; 16:192-200. [PMID: 36997833 DOI: 10.1007/s12178-023-09829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE OF REVIEW Lumbar disc herniation (LDH) is a common injury experienced by athletes and has important clinical considerations for athletes including the timing of return to sport. Lumbar disc herniation may result in loss of individual training and playing time for athletes. Current literature is inconclusive on whether surgical or conservative treatment of LDH is superior in athletes. Our aim was to review the literature to identify return-to-play (RTP) rates and performance outcomes following operative and nonoperative treatment of LDH in the athletic population. RECENT FINDINGS Athletes have unique measurements of successful treatment for LDH such as time to return to their sport and performance outcomes that are not as applicable as traditional metrics. It is suggested that surgical treatment may provide a quicker return to sport than nonoperative care in athletes. Additionally, conflicting findings have been seen in career length and performance status based on sport, often due to short and tumultuous career patterns. These differences may be seen based on the unique physical demands of each sport, different motivations to prolong sport, or other confounding factors that could not be controlled for or unrelated to LDH. Recent literature on RTP outcomes in athletes treated for LDH show variable results based on sport. Further research is needed to assist physicians and athletes in making the decision to undergo conservative or surgical treatment of LDH in the athletic population.
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Affiliation(s)
| | - Kyle J Holmberg
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Jon E Hammarstedt
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Jonathan R Acosta
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kevin Monahan
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan D Sauber
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Daniel T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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4
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Abola MV, Lin CC, Colasanti CA, Schreiber-Stainthorp W, Passias PG. Treatment Outcomes in American Football Players After Intervertebral Disk Herniation: Systematic Review and Meta-Analysis. Neurosurgery 2022; 90:51-58. [PMID: 34982870 DOI: 10.1227/neu.0000000000001746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND American football players are at increased risk for many forms of spinal injury. Intervertebral disk herniations are particularly concerning as they are the leading cause of days lost to injury and can have long-term effects on player careers. Disk herniation management plays a major role in the likelihood and success of return-to-play (RTP). OBJECTIVE To assess the incidence, demographic variables, treatment approaches, outcomes, and RTP rates of disk herniations in American football players. METHODS A systematic review of the literature investigating disk herniations in American football players using PubMed, Cochrane Library, and Embase was performed. RTP estimates were calculated by pooling study-specific data using a random-effects model. RESULTS Four hundred twenty-two studies were identified, with 18 meeting inclusion criteria. Offensive and defensive linemen were the 2 most commonly injured positions. Players undergoing operations were on average younger, with higher body mass indexes, fewer seasons played, and longer post-treatment careers than nonsurgical counterparts. Postsurgical recovery periods lasted an average 106 d, with a mean RTP duration of 33 games over 2.7 yr and an 8.45% reoperation rate. Operative treatment offered a nonsignificant increase in the likelihood of return-to-play compared with nonoperative treatment (odds ratio = 2.81, 95% CI 0.83-9.51). CONCLUSION Disk herniations are a common injury, with surgery potentially improving post-treatment outcomes. The literature suffers from heterogeneous definitions of RTP and varying performance metrics, making it difficult to draw clear conclusions. To better understand the impact of disk herniation and treatment on player health and performance, more studies should be performed prospectively and with standardized metrics.
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Affiliation(s)
- Matthew V Abola
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
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5
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Gould HP, Winkelman RD, Tanenbaum JE, Hu E, Haines CM, Hsu WK, Kalfas IH, Savage JW, Schickendantz MS, Mroz TE. Epidemiology, Treatment, and Performance-Based Outcomes in American Professional Baseball Players With Symptomatic Spondylolysis and Isthmic Spondylolisthesis. Am J Sports Med 2020; 48:2765-2773. [PMID: 32795194 DOI: 10.1177/0363546520945727] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Repetitive lumbar hyperextension and rotation during athletic activity affect the structural integrity of the lumbar spine. While many sports have been associated with an increased risk of developing a pars defect, few previous studies have systematically investigated spondylolysis and spondylolisthesis in professional baseball players. PURPOSE To characterize the epidemiology and treatment of symptomatic lumbar spondylolysis and isthmic spondylolisthesis in American professional baseball players. We also sought to report the return-to-play (RTP) and performance-based outcomes associated with the diagnosis of a pars defect in this elite athlete population. STUDY DESIGN Descriptive epidemiology study. METHODS A retrospective cohort study was conducted among all Major and Minor League Baseball (MLB and MiLB, respectively) players who had low back pain and underwent lumbar spine imaging between 2011 and 2016. Players with radiological evidence of a pars defect (with or without listhesis) were included. Analyses were conducted to assess the association between player-specific characteristics and RTP time. Baseball performance metrics were also compared before and after the injury episode to determine whether there was an association between the diagnosis of a pars defect and diminished player performance. RESULTS During the study period of 6 MLB seasons, 272 professional baseball players had low back pain and underwent lumbar spine imaging. Overall, 75 of these athletes (27.6%) received a diagnosis of pars defect. All affected athletes except one (98.7%) successfully returned to professional baseball, with a median RTP time of 51 days. Players with spondylolisthesis returned to play faster than those with spondylolysis, MLB athletes returned faster than MiLB athletes, and position players returned faster than pitchers. Athletes with a diagnosed pars defect did not show a significant decline in performance after returning to competition after their injury episode. CONCLUSION Lumbar pars defects were a common cause of low back pain in American professional baseball players. The vast majority of affected athletes were able to return to competition without demonstrating a significant decline in baseball performance.
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Affiliation(s)
- Heath P Gould
- MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | | | | | - Emily Hu
- Cleveland Clinic, Cleveland, Ohio, USA
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Bensler S, Walde M, Fischer MA, Pfirrmann CWA, Peterson CK, Sutter R. Comparison of treatment outcomes in lumbar disc herniation patients treated with epidural steroid injections: interlaminar versus transforaminal approach. Acta Radiol 2020; 61:361-369. [PMID: 31265320 DOI: 10.1177/0284185119858681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The study describes the difference of pain reduction in interlaminar and transforaminal injections. Purpose To compare treatment outcomes after interlaminar versus transforaminal epidural steroid injections in patients with disc herniations at the level L3/4–L5/S1 and analyze associated magnetic resonance imaging (MRI) findings. Material and Methods This retrospective comparative effectiveness outcome study included 198 patients with computed tomography (CT)-guided interlaminar (n = 99) or transforaminal (n = 99) epidural injections with particulate steroids. Pain levels at baseline and one day, one week, and one month after injection were assessed using the 11-point Numerical Rating Scale for Pain. Overall improvement was assessed after one day, one week, and one month using the Patients Global Impression of Change. MRI analysis was performed by two radiologists. Student’s t-test, Chi-square test, and Fisher’s exact test were calculated. Results Baseline pain scores were equal for interlaminar and transforaminal injections (6.23, SD = 2.10 vs. 5.84, SD = 2.02; P = 0.18). There were no significant differences in improvement between the interlaminar and transforaminal approach of epidural steroid injections after one day (30.5% vs. 21.2%, P = 0.432), one week (41.7% vs. 40.8%, P = 1.000), and one month (53.3% vs. 43.9%, P = 0.322), but there was a trend towards better effect of interlaminar injections at one day and one month. The change in Numerical Rating Scale for Pain scores showed no significant differences between the two cohorts after one day, one week, and one month ( P ≥ 0.115). None of the MR findings predicted a better or worse outcome ( P ≥ 0.171). Conclusion Interlaminar and transforaminal injections with particulate corticosteroids were equally effective, with a non-significant advantage of interlaminar injections at one day and one month. None of the MR findings were associated with treatment outcomes.
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Affiliation(s)
- Susanne Bensler
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Melissa Walde
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael A Fischer
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian WA Pfirrmann
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Cynthia K Peterson
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Plais N, Salzmann SN, Shue J, Sanchez CD, Urraza FJ, Girardi FP. Spine Injuries in Soccer. Curr Sports Med Rep 2019; 18:367-373. [DOI: 10.1249/jsr.0000000000000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Kluczynski MA, Kelly WH, Lashomb WM, Bisson LJ. A Systematic Review of the Orthopaedic Literature Involving National Football League Players. Orthop J Sports Med 2019; 7:2325967119864356. [PMID: 31457068 PMCID: PMC6702781 DOI: 10.1177/2325967119864356] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Orthopaedic injuries of National Football League (NFL) players can have a deleterious effect on their health, with minimal to no high-level evidence on the management of these injuries. Purpose To summarize all data published between January 1980 and March 2018 on orthopaedic injuries experienced by NFL candidates and professional players in the NFL. Study Design Systematic review; Level of evidence, 4. Methods A literature search of studies examining orthopaedic injuries in the NFL was performed through the PubMed, Embase, and CINAHL databases. The review included studies of orthopaedic injuries in college football recruits attending the NFL Combine as well as professional NFL players. Excluded were studies of nonorthopaedic injuries, such as concussions, traumatic brain injury, facial injuries, and vascular injuries, as well as case reports. Results A total of 147 articles met the inclusion criteria and were divided into 11 topics based on anatomic site: general (16%), spine (13%), shoulder (13%), elbow (3%), hand and wrist (3%), trunk (0.7%), hip and pelvis (7%), thigh (3%), knee (24%), ankle (5%), and foot (12%). Of these studies, 74% were of level 4 evidence. Most studies obtained data from the NFL Combine database (26%), by searching the internet (24%), and via the NFL Injury Surveillance System (22%). Studies using internet search methods to identify injuries consistently found fewer participants than studies using the NFL Injury Surveillance System. Conclusion This systematic review provides National Collegiate Athletic Association and NFL team physicians with a single source of the most current literature regarding orthopaedic injuries in NFL players. Most research was published on knee, spine, shoulder, and foot injuries and consisted of level 4 evidence. A substantial portion of the published literature was based on data obtained from internet searches and may not accurately represent the NFL population.
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Affiliation(s)
- Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - William H Kelly
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - William M Lashomb
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
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9
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Intervertebral disc herniation in elite athletes. INTERNATIONAL ORTHOPAEDICS 2018; 43:833-840. [DOI: 10.1007/s00264-018-4261-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022]
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10
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Abstract
OBJECTIVE To review the literature guiding all aspects of the use of injectable corticosteroids for painful musculoskeletal conditions, with a focus on the treatment of athletes. DATA SOURCES An extensive search of the literature was completed including search terms of corticosteroid, steroid, athlete, and injection, among others. Additional articles were used after being identified from previously reviewed articles. MAIN RESULTS Injections of corticosteroids for a variety of painful conditions of the extremities and the axial spine have been described. Numerous minor and major complications have been reported, including those with a high degree of morbidity. There is a dearth of published research on the use of corticosteroid injections in athletes, with most of the research on this topic focused on older, nonathlete populations. Generally, these injections are well tolerated and can provide short-term pain improvement with little or no long-term benefits. CONCLUSIONS Corticosteroid injections should be used cautiously in athletes and only after a full consideration of the pharmacology, pathogenesis of disease, potential benefits, complications, factors specific to the athlete, and rules of athletic governing bodies. Corticosteroid injections are just one component of a comprehensive rehabilitation plan available to the physician providing care to athletes.
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Abstract
OBJECTIVE To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes. DESIGN Systematic literature review. DATA SOURCES Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded. MAIN RESULTS Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared. CONCLUSIONS Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.
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Gadia A, Shah K, Nene A. Outcomes of Various Treatment Modalities for Lumbar Spinal Ailments in Elite Athletes: A Literature Review. Asian Spine J 2018; 12:754-764. [PMID: 30060387 PMCID: PMC6068423 DOI: 10.31616/asj.2018.12.4.754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/17/2017] [Indexed: 01/11/2023] Open
Abstract
Lumbar spinal injuries are common in elite athletes, who can present with a spectrum of ailments ranging from lumbar strain to prolapsed intervertebral discs. Sequelae can include neurological impairment and lumbar instability among other possible outcomes. This group of patients is unique in terms of their clinicoradiological presentation and treatment modalities. The primary goals of treatment are a rapid return to play and prevention of recurrence, thus prolonging the athlete’s professional career. Treatment modalities can range from activity restriction to nerve root blocks and surgery. A successful treatment outcome is based on timely diagnosis, treatment suiting the demands of the particular sport, and early rehabilitation. A multidisciplinary team approach involving the coach, rehabilitation specialist, pain management specialist, and spine surgeon helps in planning appropriate treatment. In this article, we review special considerations in the elite athletic population with lumbar spinal ailments as well as the outcomes of various treatment modalities.
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Affiliation(s)
- Akshay Gadia
- Department of Spine, Wockhardt Hospital, Mumbai, India
| | | | - Abhay Nene
- Department of Spine, Wockhardt Hospital, Mumbai, India
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13
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Abstract
Lumbar disk herniation, degenerative disk disease, and spondylolysis are the most prevalent lumbar conditions that result in missed playing time. Lumbar disk herniation has a good prognosis. After recovery from injury, professional athletes return to play 82% of the time. Surgical management of lumbar disk herniation has been shown to be a viable option in athletes in whom nonsurgical measures have failed. Degenerative disk disease is predominately genetic but may be accelerated in athletes secondary to increased physiologic loading. Nonsurgical management is the standard of care for lumbar degenerative disk disease in the elite athlete. Spondylolysis is more common in adolescent athletes with back pain than in adult athletes. Nonsurgical management of spondylolysis is typically successful. However, if surgery is required, fusion or direct pars repair can allow the patient to return to sports.
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14
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Casagranda BU, Thurlow PC. The Role of Imaging in Determining Return to Play. Radiol Clin North Am 2016; 54:979-88. [DOI: 10.1016/j.rcl.2016.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Bensler S, Sutter R, Pfirrmann CWA, Peterson CK. Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids? Eur Radiol 2016; 27:1505-1511. [PMID: 27436028 DOI: 10.1007/s00330-016-4498-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/28/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the outcomes of patients after interlaminar computed tomography (CT)-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. METHODS 531 consecutive patients were treated with CT-guided lumbar interlaminar epidural injections with steroids and local anaesthetics. 411 patients received a particulate steroid and 120 patients received a non-particulate steroid. Pain levels were assessed using the 11-point numerical rating scale (NRS) and overall reported 'improvement' was assessed using the Patients Global Impression of Change (PGIC) at 1 day, 1 week and 1 month post-injection. Descriptive and inferential statistics were applied. RESULTS Patients receiving particulate steroids had statistically significantly higher NRS change scores (p = 0.0001 at 1 week; p = 0.0001 at 1 month). A significantly higher proportion of patients receiving particulate steroids reported relevant improvement (PGIC) at both 1 week and 1 month post injection (p = 0.0001) and they were significantly less likely to report worsening at 1 week (p = 0.0001) and 1 month (p = 0.017). CONCLUSION Patients treated with particulate steroids had significantly greater pain relief and were much more likely to report clinically relevant overall 'improvement' at 1 week and 1 month compared to the patients treated with non-particulate steroids. KEY POINTS • CT-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. • Good outcomes with particulate steroids. • Less pain relief in patients with non-particulate steroids. • Less improvement in patients with non-particulate steroids.
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Affiliation(s)
- Susanne Bensler
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Cynthia K Peterson
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
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Burgmeier RJ, Hsu WK. Spine surgery in athletes with low back pain-considerations for management and treatment. Asian J Sports Med 2014; 5:e24284. [PMID: 25741419 PMCID: PMC4335480 DOI: 10.5812/asjsm.24284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/09/2014] [Indexed: 11/16/2022] Open
Abstract
While degenerative lumbar spine conditions are common in the general population, there are unique considerations when diagnosed in high-level athletes. Genetic factors have been identified as a more significant contributor to the development of degenerative disc disease than occupational risks, however, some have postulated that the incessant training of young, competitive athletes may put them at a greater risk for accelerated disease. The evidence-based literature regarding lumbar disc herniation in elite athletes suggests that it is reasonable to expect excellent clinical outcomes and successful return-to-sport after either operative or non-operative treatment regardless of sport played. However, those athletes who require repetitive torque on their lumbar spines may have poorer long-term outcomes if surgical treatment is required for this condition. Painful spondylolysis in the athlete can often be treated successfully with non-operative treatment, however, if surgery is required, pars repair techniques provides a motion-sparing alternative that may lead to successful return to sport.
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Affiliation(s)
- Robert J. Burgmeier
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States
- Corresponding author: Robert J. Burgmeier, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States. Tel: +1-3129264444, E-mail:
| | - Wellington K. Hsu
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States
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Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation. Asian Spine J 2014; 8:646-52. [PMID: 25346818 PMCID: PMC4206815 DOI: 10.4184/asj.2014.8.5.646] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/11/2014] [Accepted: 02/19/2014] [Indexed: 12/18/2022] Open
Abstract
Study Design Prospective study. Purpose We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation. Overview of Literature To our knowledge, there is no previous report of such a comparison in these patients. Methods The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection. Results The degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods. Conclusions In the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences.
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Nandyala SV, Marquez-Lara A, Frisch NB, Park DK. The Athlete’s Spine—Lumbar Herniated Nucleus Pulposus. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Br J Sports Med 2013; 48:929-38. [PMID: 23322894 PMCID: PMC4033203 DOI: 10.1136/bjsports-2012-091400] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme—biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence.
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Affiliation(s)
- Peter Brukner
- Departmernt of Sports Medicine and Sports Science, Liverpool Football Club, , Liverpool, UK
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Petron DJ, Prideaux CC, Likness L. Interventional Spine Procedures in Athletes. Curr Sports Med Rep 2012; 11:335-40. [DOI: 10.1249/jsr.0b013e3182770585] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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