High Rates of Successful Return to Competitive Athletics After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Regardless of Distal Fusion Level

Abstract

Study Design. Prospective cohort. Objective. To determine if distal spinal fusion level is associated with postoperative sport participation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Summary of Background Data. The concept of “saving a level” during PSF for AIS refers to minimizing the distal extent of lumbar fusion to theoretically allow for increased postoperative spinal mobility and a more predictable return to athletic activity, as well as minimizing the risk of degenerative disc disease. There are few prospective studies evaluating the correlation between distal fusion level and timing of return to sports. Materials and Methods. Adolescent patients undergoing PSF for AIS between 2009 and 2019 were approached at their presurgical visit to participate in this prospective study. Participants were followed for a minimum of 2 years after surgery. Sports participation (classified by sport type and level of competitiveness) and radiographic data were collected at the initial visit. At each postoperative visit, it was noted whether patients returned to the same sport type and level of competitiveness. Results. After an a priori power calculation was performed, a total of 106 participants were included in the analysis with a mean age of 14 ± 2 years. Distal fusion levels ranged from T11 to L4. There was no significant association between distal fusion level and return to the same level of sports participation (P = 0.192). Of the participants, 93% returned to sports with no significant differences by distal fusion level (P = 0.081). Distal fusion level demonstrated no difference in return to preoperative sport (P = 0.486) or return to the same type of sport (P = 0.247). Conclusions. This study found no association between distal fusion level and postoperative sports participation. Even though many patients may elect to change sports, nearly all patients returned to sports, and the majority of patients returned to the same level of sports competition or higher after PSF for AIS.

Return to play following spine surgery

“…It is reasonable to think that as LIV becomes more distal and spine motion decreases, return to play will also decrease. However, this finding has not been corroborated in more recent prospective studies, which have shown that LIV is not predictive of return to sport, and that patients with a more distal LIV can return to sport at high rates that are not significantly different than those with a more proximal LIV ( 22 , 24 ). Various other factors have been proposed as more predictive of rates of return to play.…”

“…The lack of consensus regarding these findings suggests that external patient factors such as motivation or changes in preference may play an equally significant role in returning to sport as any surgical variable. Athletes report barriers such as back pain, loss of flexibility, deconditioning, and fear of injury as common reasons for difficulty returning to the same level of play (19,22,23). These factors may drive some athletes to change sports as well, as trends away from collision and high impact sports towards non-contact sports has been observed at rates as high as 37% (23).…”

“…Athletes report barriers such as back pain, loss of flexibility, deconditioning, and fear of injury as common reasons for difficulty returning to the same level of play (19,22,23). These factors may drive some athletes to change sports as well, as trends away from collision and high impact sports towards non-contact sports has been observed at rates as high as 37% (23).…”

“…While most patients can compete at similar levels and within the same sport, it is important to note that some athletes may choose to switch sports. There is a studied trend away from contact and collision sports after spinal fusion surgery, such as horse riding, ballet, soccer and volleyball, to non-contact and non-collision sports, such as cycling and swimming, at rates as high as 37% (21,23).…”

What’s New in Pediatric Orthopaedics

“…In this study, the return to contact sports was delayed compared with the return to non-contact sports. In the second study, return to sport was not associated with the distal fusion level among 106 patients with adolescent idiopathic scoliosis 51 . Participants could return to sport as early as 10 weeks, and most returned to the same sport at the same level of competition.…”