Guidelines for Rehabilitation and Return to Play After Cervical Surgery in a General Athletic Population: A Delphi Analysis

Abstract

Objective: Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no clear guidelines for this are currently available. The aim of this study was to create tentative guidelines for rehabilitation and RTP after cervical surgery in a general sporting population. Design: Five-step Delphi analysis. Settings: Primary, secondary, and tertiary medical practitioners. Participants: Panel of Belgian neurosurgeons, orthopedic surgeons, physiotherapists, and physical and rehabilitation medicine practitioners. Assessment: Round 1 (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3), experts ranked these items in a chronological order. Contraindications and criteria to start each rehabilitation step were linked in round 4 (R4). In round 5 (R5), panelists ranked theses about contraindications and criteria on a 5-point Likert scale. Main Outcome Measures: Theses scoring ≥10% “oppose” or “strongly oppose” were rejected. Results: The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4, and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed. Conclusions: This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and RTP after cervical surgery in a general athletic population. Tentative guidelines and timetable are proposed. Key messages from these guidelines are (1) Rehabilitation should start before surgery with education; (2) Rehabilitation should be patient-tailored; and (3) An unstable arthrodesis is an absolute contraindication for RTP.

Expert Consensus on the Contraindications and Cautions of Foam Rolling—An International Delphi Study

“…Besides the collection of clinical data as the gold standard model, obtaining a reliable opinion consensus of experts represents another way of gaining insight into potential contraindications and cautions [25]. In view of the scarcity of papers targeting contraindications and cautions of foam rolling, our study aimed to provide initial data on expert opinions using a Delphi process, which has been widely used across numerous disciplines to seek expert opinions in an iterative structured manner [26][27][28].…”

Perspectives of Endoscopic Spine Surgery in Athletes and Practitioners of Physical Activity

“…General recommendations are that an athlete should have a painless active range of motion, painless for specific exercises, and total strength without neurological deficit [100]. Regarding cervical spine surgery, RTP is indicated in cases of a singlelevel anterior cervical discectomy and fusion, in the lack of neurological deficits and normal cervical range of motion [101][102][103]. In case of multilevel fusion or other surgical options like laminoplasty, posterior laminectomy and fusion or laminoforaminotomy, there is no consensus about RTP.…”

“…In case of multilevel fusion or other surgical options like laminoplasty, posterior laminectomy and fusion or laminoforaminotomy, there is no consensus about RTP. In the athlete population, available data about RTP after cervical surgery is narrow because other factors other than health issues should be considered, such as personal finances and team performance [101]. As thoracic injuries are not common, there is no case report or case series in the literature regarding ESS of thoracic levels in athletes or practitioners of physical activity, therefore, there is no consensus about RTP in these cases.…”