Microscopic lumbar discectomy results for 60 cases in professional and Olympic athletes

doi:10.1016/S1529-9430(02)00569-7

The Spine Journal

Volume 3, Issue 2, March–April 2003, Pages 100-105

https://doi.org/10.1016/S1529-9430(02)00569-7 Get rights and content

Abstract

Background context: There is no documented information indicating time for return to play after lumbar discectomy in professional and Olympic athletes. Purpose: To determine the rate of return to sport and the average time of recovery in elite athletes undergoing microscopic lumbar discectomy (MLD). Study design: Between 1984 and 1998, the senior author performed 60 MLDs on 59 professional and Olympic athletes with lumbar herniated nucleus pulposus. Patient sample: Sixty consecutive MLDs performed on professional and Olympic athletes were reviewed. Outcome measures: The rate of return and the average time to return to sport were determined. Also, the distribution of pain and presence of neurologic deficits were recorded. Methods: A retrospective review was performed. Results: Follow-up indicated that all but 7 of the 60 cases had returned to their sport, including one who underwent a second MLD for a herniation at an adjacent level. The average time from surgery to return was 5.2 months for the entire group, with a range of 1 to 15 months. Conclusion: MLD was effective in correcting the problems that forced the athletes to seek help, and the time to return often depends on factors other than their medical condition. Postoperatively, a complete trunk stabilization rehabilitation program was effective in returning these athletes to a high level of competition.

Introduction

In the business of sports, an athlete with an injured back is a nonproductive competitor. To the professional athlete, back injuries frequently result in poor performance or an inability to perform, leading to a loss of income or, even worse, early retirement from the sport. For the injured Olympian, an injured back may mean a long delay in, or possibly the early conclusion to, a promising pursuit of athletic excellence.

Although surgery can frequently correct the athletic injury, there remain the issues of whether surgical correction is sufficient to allow the athlete to return to the rigors of the sport and, if so, whether it will take weeks, months or years to make that return. The return-to-normal function issue has been little studied; the return-to-normal function issue in sports specifically has had even less attention.

Section snippets

Methods and materials

A total of 59 professional and Olympic athletes presenting with lumbar herniated nucleus pulposus requiring surgical intervention, including one patient who underwent a second microscopic lumbar discectomy (MLD) for a herniation at an adjacent level, were operated on with MLD by one of the authors (RGW III) between 1984 and 1998.

A retrospective review of all of the cases was carried out to determine the rate of return to work and the average time of recovery, as indicated by the length of time

Results

Average age of the patients at the time of surgery was 26.8 years (range, 19 to 37). All patients presented with low back and/or leg pain. Thirty-nine patients reported leg pain greater than back pain, 19 patients reported back pain greater than leg pain, and two patients reported equal back and leg pain. Subjects had experienced an average of 5.2 months of pain (range, 1 week to 48 months) before initial presentation. A total of 17 patients had a neurologic deficit. Neurologic deficits (motor

Discussion

Microscopic lumbar discectomy has been reported to be a successful procedure, with up to 90% recovery in some series 1, 2. Our return to full activity of 88% compared favorably with other studies 1, 3, 4, 5, 6, 7, 8, 9. That the majority of the athletes in this study returned to competition, after what would appear to be a short hiatus from their physically demanding occupation or avocation, might be ascribed to the relative youth of the patients and their probable high motivation to recover

Conclusion

Microscopic lumbar discectomy, when combined with an effective postoperative rehabilitation program, can be effective in returning athletes with lumbar herniated nucleus pulposus to their sport in a timely manner.

References (19)

S.J. Atlas et al.
The Maine Lumbar Spine Society, part II1-year outcomes of surgical and nonsurgical management of sciatica
Spine
(1996)
C.T. Pappas et al.
Outcome analysis in 654 surgically treated lumbar disc herniations
Neurosurgery
(1992)
C.D. Abernathey et al.
Results of microsurgery
G.F. Findlay et al.
A 10-year follow-up of the outcome of lumbar microdiscectomy
Spine
(1998)
Mannismaki P, Vanharanta H, Puranen J. Disability 20–30 years after disc surgery: a follow-up of 162 patients....
H.M. Mayer
Spine updatepercutaneous lumbar disc surgery
Spine
(1994)
A.J. Moore et al.
Long-term results of microlumbar discectomy
Br J Neurosurg
(1994)
G. Waddel et al.
Failed lumbar disc surgery and repeat surgery following industrial injuries
J Bone Joint Surg
(1979)
R.W. Williams
Results of microsurgery

There are more references available in the full text version of this article.

Cited by (50)

Lumbar Disk Herniations and Radiculopathy in Athletes
2021, Clinics in Sports Medicine
Endoscopic Spine Surgery in Athletes: Case Series and Review of Literature
2021, World Neurosurgery
Citation Excerpt :
Nonetheless, most guidelines acknowledge that contact sports are safe after simple spinal decompression surgeries.30 One observational study found that a series of 60 professional and Olympic athletes returned to play at an average of 5.2 months after their microscopic lumbar decompression.31 In National Football League (NFL) players with lumbar disc herniations who underwent surgery, 80% returned to play.2
Degenerative spine disease is common in athletes and can progress to requiring surgical intervention. Traditional open surgical techniques necessitate prolonged recovery time and time away from play. Newly developed endoscopic surgical techniques may promote faster healing and recovery, and increased return to play. The goal of this paper is to summarize the current evidence in return to play after spine surgery and to present our series of 3 athletes who underwent endoscopic spine surgery.
A complete search of all PubMed indexed articles pertaining to spine surgery in athletes was conducted. This was supplemented by a 3-patient case series of our own endoscopic spine experience in athletes.
There are no current widely accepted guidelines for return to play after spinal surgery. The best evidence available cites a return to play of 81% at 5.2–8.7 months after traditional open and minimally invasive surgery, and endoscopic surgery produces an average 88% return to play rate at 3 months.
Although return to play can vary widely, case-based evidence as well as biomechanical principles support endoscopic spine surgery as a viable surgical modality for the treatment of spinal pathologies in athletes.
Transforaminal percutaneous endoscopic discectomy for lumbar disc herniation in athletes under the local anesthesia
2019, Journal of Orthopaedic Science
Citation Excerpt :
Some studies reported that patients with LDH in the general population improved both through surgery and usual conservative care in the long term [26,27]. However, athletes need to return to play their sports quickly and sometimes they need to undergo surgery, so therefore a less invasive surgical procedure is necessary, in order to preserve muscle and prevent bone damage such as PED [5,6]. However, reports on the effect of PED on LDH in athletes are rare.
Percutaneous endoscopic discectomy (PED) has been reported to be less invasive and effective procedure for lumbar disc herniation (LDH). Damage to the back muscle is considered minimal, which is particularly important for athletes. However, the results of PED for LDH in athletes have not been reported well. The purpose of this study was to evaluate the clinical outcomes of PED for LDH in athletes.
We retrospectively analyzed 21 athlete patients with LDH who had undergone PED. All patients received athletic rehabilitation immediately after surgery. The clinical outcomes were evaluated from the visual analogue scale (VAS) for leg pain and low back pain (LBP), the Oswestry Disability Index (ODI), complications and periods of return to sport.
There were 18 men and 3 women, and the mean age at the time of surgery was 22.9 years (range: 15–43 years). The mean VAS scores for leg pain before and after surgery were 64.3 ± 2.7 mm and 12.4 ± 1.4 mm, respectively. The mean VAS scores for LBP before and after surgery were 62.1 ± 2.2 mm and 10.5 ± 1.1 mm, respectively. The mean ODI scores before and after surgery were 31.3 ± 14.0% and 14.6 ± 7.1%, respectively. The VAS for leg pain, as well as the LBP and ODI, significantly improved after surgery. There were no complications related to the surgery. Ninety-five percent (20/21) returned to play sports at the same performance level as before the procedure by an average of 9.2 weeks after PED.
PED is a minimally invasive and effective procedure for patients with LDH, especially in athletes. Not only the patients' leg pain but also their discogenic LBP improved. PED has the benefits of preservation of normal posterior structures and a faster return to sports.
Lumbar Spine Microdiscectomy Surgical Rehabilitation
2017, Clinical Orthopaedic Rehabilitation: A Team Approach, Fourth Edition
Return to Play After Lumbar Spine Surgery
2016, Clinics in Sports Medicine
Citation Excerpt :
These studies suggest excellent return to play rates and variable posttreatment performance depending on the sport played; however, time to return is not always clear and differences in methodology make comparing results difficult. Watkins and colleagues24 initially evaluated 60 cases of microdiscectomy in 59 Olympic and professional athletes with lumbar disc herniation between 1984 and 1998. They found that 90% return to play at an average of 5.2 months (range, 1–15).
Return to play considerations for cervical spine injuries in athletes
2014, Physical Medicine and Rehabilitation Clinics of North America
Citation Excerpt :
Although some cervical spine injuries have clearer guidelines, RTP decisions for many cervical injuries remain controversial. Authors have proposed criteria to guide RTP decision-making in cervical spine fractures,9–12 stingers,13–15 cervical stenosis and cervical cord neuropraxia (CCN),12,14,16 and herniated nucleus pulposis.17–19 However, the relative infrequency of these injuries has limited the ability to perform randomized clinical trials, elucidate their epidemiology and risk factors, or produce validated outcomes measurements.

View all citing articles on Scopus

^☆: FDA device/drug status: not applicable.

^☆☆: Nothing of value received from a commercial entity related to this research.

View full text

Clinical studiesMicroscopic lumbar discectomy results for 60 cases in professional and Olympic athletes☆,☆☆

Abstract

Introduction

Section snippets

Methods and materials

Results

Discussion

Conclusion

The Maine Lumbar Spine Society, part II1-year outcomes of surgical and nonsurgical management of sciatica

Spine

Outcome analysis in 654 surgically treated lumbar disc herniations

Neurosurgery

Results of microsurgery

A 10-year follow-up of the outcome of lumbar microdiscectomy

Spine

Spine updatepercutaneous lumbar disc surgery

Spine

Long-term results of microlumbar discectomy

Br J Neurosurg

Failed lumbar disc surgery and repeat surgery following industrial injuries

J Bone Joint Surg

Results of microsurgery

Clinical studies
Microscopic lumbar discectomy results for 60 cases in professional and Olympic athletes☆,☆☆