Outcomes of Lumbar Discectomy in Elite Athletes: The Need for High-level Evidence

Abstract

Background Although lumbar discectomy for treatment of lumbar disc herniation in the general population generally improves patients' pain, function, and validated outcomes scores, results of treatment in elite athletes may differ because of the unique performance demands required of competitive athletes. Questions/purposes We performed a systematic review to answer the following questions: (1) What proportion of athletes return to play after lumbar discectomy, and what is the effect of sport? (2) What is the expected recovery time after lumbar discectomy in elite athletes? (3) What is the expected career length and performance of elite athletes after lumbar discectomy? Methods We performed a systematic literature review of articles of lumbar discectomy in the elite athlete population through the MEDLINE and EMBASE databases from 1947 to 2013. Elite athletes were defined as professional, Olympic, or National Collegiate Athletic Association Division I collegiate level. A hand search of the references of all key articles was performed to ensure inclusion of all relevant studies. Information regarding study design, types of athletes, level of sport, recovery time, return to sport, length of career after surgery, and career performance after surgery was extracted. Ten articles met the inclusion and exclusion criteria for this review. These articles consisted of levels III and IV data and were graded based on the Methodological Index for Non-Randomized Studies (MINORS) scale. Results Overall, the studies included in this review found that 75% to 100% of athletes were able to return to elite competition after operative treatment. In general, a higher proportion of baseball players returned to elite competition compared with other athletes. The reported recovery period after lumbar discectomy ranged from 2.8 to 8.7 months. The average career length after lumbar discectomy ranged from 2.6 to 4.8 years. Elite athletes reached an average of 64.4% to 103.6% of baseline preoperative statistics after lumbar discectomy with variable performance based on sport. Conclusions A high proportion of elite athletes undergoing lumbar discectomy return to play with variable performance scores on return. Future prospective studies are needed to compare the recovery time, career longevity, and performance for athletes undergoing lumbar discectomy versus nonoperative treatment for lumbar disc herniation.

Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations

“…Studies have found similar results when comparing microdiscectomy to nonsurgical treatments in elite NFL players [11]. Recovery from lumbar discectomy in elite athletes has been reported to range from 2.8 to 8.7 months with an average career length of 2.6 to 4.8 years [63].…”

Spine Surgery in Athletes With Low Back Pain-Considerations for Management and Treatment

“…In a study of 137 National Football League (a difference in outcome) players with LDH, surgical treatment led to a significantly longer career and higher return to play rate than those treated non-operatively ((37 months vs. 24 months, respectively; P = 03 ) and (36 games vs. 20 games, respectively; P = 002)) ( 10 ). Similarly, Schroeder et al reported 85% RTP rates in 87 hockey players with no significant difference in rates or outcomes between the surgical and nonsurgical cohorts, an outcome found in major league baseball players as well ( 28 , 35 ). These studies conclude that although a diagnosis of lumbar disc herniation has career-ending potential, most players are able to return to play and generate excellent performance-based outcomes, even if surgery is required ( 10 ).…”

“…For example, American football players have a significantly lower rate of return-to-play than baseball athletes, which could be explained by the physical nature of the respective sports ( 31 ). Furthermore, comparative studies show that a lumbar discectomy may lead to a shorter career in baseball players compared to non-operative treatment (233 versus 342 games, respectively; P = 0.08), suggesting that physical demands unique to this sport may lead to a difference in outcome ( 35 ). While the etiology of this effect has yet to be proven, some authors have postulated that the twisting nature of some sports may predispose players to chronic problems after disc surgery.…”

Symptomatic L4-L5 Disc Herniation in a Professional Hockey Player

“…The average age of a professional NHL hockey player is 25.5 ± 4.4 years of age. 3 Because this injury took place in a 39-year-old player, there are physiological changes that must be accounted for that are not common in younger athletes including arthritic changes in the bone and a decrease in the fluid in the intervertebral discs. After 19 years of professional hockey, the patient has experienced numerous stresses on their lumbar spine compared to a rookie.…”