Assessment of Outcomes of Spine Surgery in Indian Athletes Involved in High-End Contact Sports

Long-term results and surgical strategy development for degenerative disease treatment in athletes: a retrospective single-center study

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.

Return to sports following discectomy: does a consensus exist?

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.

Cervical and Lumbar Disk Replacement in Athletes: Is It Safe to Return to Play? A Systematic Review of the Scientific Literature and Lay Press

BACKGROUND AND OBJECTIVES

Cervical/lumbar total disk replacements (TDRs) are often performed for degenerative conditions but rarely in athletes. Therefore, we sought to conduct a systematic review of athletes undergoing TDRs of both the scientific literature and lay press, with an emphasis on contact sport athletes.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed/Embase/Cochrane/Scopus/Web of Science databases were queried for all primary literature reporting TDRs in athletes, including both cervical/lumbar disk replacements (CDRs/LDRs). Sports were dichotomized into contact vs limited/noncontact. Because of the public nature of injuries in elite athletes, the lay press was also queried.

RESULTS

A total of 488 scientific studies were screened, of which 10 met inclusion criteria. Cervical: seven studies reported CDRs in 53 athletes, of which 7 were professional, 22 semiprofessional, and 24 recreational. Of the seven professional athletes, there was one contact sport athlete (kickboxer). All 7/7 professional and 21/22 semiprofessional athletes successfully returned-to-play at 8-52 weeks without complication. Lumbar: Three studies discussed LDRs in 51 athletes, of which 17 were professional, 6 semiprofessional, and 28 recreational. Of the 17 professional athletes, eight played contact sports (2 boxing, 2 alpine skiing, 2 soccer, judo, rugby). All 17 professional and 6 semiprofessional athletes successfully returned to play at 9-21 weeks. Lay Press: five professional contact sport athletes underwent CDRs, and all returned to play: 3 hockey, 1 mixed-martial arts, and 1 Australian-rules football.

CONCLUSION

The scientific literature and lay press revealed 14 professional contact sport athletes who underwent TDR-6 CDRs and 8 LDRs-all with successful return to play. From the little data that exist, it seems that TDR may be safe in elite athletes; however, the small number of patients highlights the major paucity of data on the safety of TDR in elite contact sport athletes.

Cervical Total Disc Replacement in Athletes: A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVE

To perform a systematic review to describe clinical characteristics, outcomes, and return to play after cervical total disc replacement (cTDR) in athletes.

SUMMARY OF BACKGROUND DATA

The role of cTDR in treating athletes with symptomatic cervical degenerative disc disease is undefined.

METHODS

A systematic search using MEDLINE through PubMed, EMBASE, and the Cochrane Library was conducted to identify all relevant literature. Data regarding study type, country in which the study was conducted, sample size, mean age, sex, type of sport, level of patient participation in sports, surgical indication, levels operated, type of implant, duration of follow-up, reoperations, surgical complications, extent of postoperative return to sports (RTSs), time to RTSs, and outcome notes were extracted from the included studies and analyzed.

RESULTS

Seven studies, including 4 case series and 3 case reports, and a total of 57 cTDR cases, were included. There was significant heterogeneity among the cTDR cases in terms of chosen sport and level of participation. Prestige LP was utilized in 51 out of 57 (89.5%) cases and 53 out of 57 (93%) cases were single-level. No reoperations were noted at a mean follow-up of 51.6 months. All patients returned to sports postoperatively. Return to training and competition occurred at a mean of 10.1 weeks and 30.7 weeks postoperatively, respectively.

CONCLUSIONS

The available evidence regarding cTDR in athletes indicates that these patients RTSs at high rates, with return to training occurring around 10 weeks and return to competition occurring around 30 weeks. Clinical outcomes in these patients are like those reported for the general population. Low-level evidence, small numbers of cases, heterogeneity in chosen sport and participation level, and predominance of a single implant type limit the conclusions that can be drawn from the current literature on this patient population.

Return to sport and active military duty after cervical disc arthroplasty: A systematic review

Introduction

Cervical disc arthroplasty (CDA) has been established as an effective treatment for cervical disc degeneration or herniation in the general population. Return to sport (RTS) outcomes in athletes remain unclear.

Objective

The purpose of this review was to evaluate RTS following single-level, multi-level, or hybrid CDA, with additional return to activity context provided by return to duty (RTD) outcomes in active-duty military.

Methods

Medline, Embase, and Cochrane were searched through August 2022 for studies that reported RTS/RTD after CDA in athletic or active-duty populations. Data was extracted on the following topics: surgical failures/reoperations, surgical complications, RTS/RTD, and postoperative time to RTS/RTD.

Results

Thirteen papers covering 56 athletes and 323 active-duty members were included. Athletes were 59% male with a mean age of 39.8 years and active-duty members were 84% male with a mean age of 40.9 years. Only 1 of 151 cases required reoperation and only 6 instances of surgical complications were reported. Classified as return to general sporting activity, RTS was observed in 100% of patients (n = 51/51) after an average of 10.1 weeks to training and 30.5 weeks to competition. RTD was observed in 88% of patients (n = 268/304) after an average of 11.1 weeks. Average follow-up was 53.1 months for athletes and 13.4 months for the active-duty population.

Conclusion

CDA displays excellent RTS and RTD rates in physically demanding populations at rates superior or equivalent to alternative treatments. Surgeons should consider these findings when determining the optimal cervical disc treatment approach in active patients.

Return to Martial Arts after Surgical Treatment of the Cervical Spine: Case Report and Systematic Review of the Literature for an Evidence-Based Approach

Background: Cervical spine injuries are considered common in athlete populations, especially in those involved in high-contact sports. In some cases, surgical treatment can be necessary, and, therefore, return-to-play (RTP) after surgery represent a notable issue. Methods: We performed a systematic review of literature according to the PRISMA statement guidelines using the following search algorithm: (("ACDF") OR ("cervical spine surgery") OR ("neck surgery") OR ("cervical discectomy") OR ("foraminotomy") OR ("cervical disc replacement")) AND (("return to play") OR ("athlete") OR ("contact sports") OR ("martial arts")). The search was performed on 21 October 2022. We included only articles in which operative treatment for the cervical spine was performed and return to martial art activity was declared in the text. Results: Eight articles were selected, including 23 athletes who practice wrestling (n = 16), kickboxing (n = 1), sumo (n = 1) or other unspecified martial arts (n = 5). We also included the case of a young judoka who underwent anterior cervical discectomy and fusion (ACDF) at our hospital. About 88% (21 of 24 cases) of martial arts practitioners returned to play after cervical spine surgery, and no major complications were reported after RTP. Four patients (16.7%) returned in 0-3 months; 41.7% (10 of 24) returned in 3-6 months; 29.2% (7 of 24) returned after a period longer than 6 months. ACDF is the most used procedure. The level of evidence in the included articles is low: only case reports are available, including some single-case studies. Moreover, a small number of cases have been reported, and the examined data are very heterogeneous. Conclusions: Return to martial arts within one year after cervical spine surgery is generally safe, even if case-by-case evaluation is, however, necessary. Further studies are necessary to corroborate the present findings in a larger population.

[Results of the study of functional recovery of professional athletes after minimally invasive lumbar fusion]

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.

[Results of minimally invasive lumbar fusion in professional athletes: a single-center retrospective study]

Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood.

OBJECTIVE

To analyze the results of minimally invasive lumbar fusion in professional athletes.

MATERIAL AND METHODS

A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery.

RESULTS

We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career.

CONCLUSION

Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.