Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis

Abstract

Background Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. Methods A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). Results The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I 2 =63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). Conclusions Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.

Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis

“…However, the extant systematic reviews primarily focused on one treatment type or one type of lumbar disc herniation. A total of four published systematic reviews 10–13 that compared surgery with non-operative treatments for lumbar disc herniation are available. One of these articles, 12 which was published in 2007, is an updated Cochrane review.…”

“…The said review only provided a descriptive analysis without meta-analysis. The last article 10 focuses on returning to sports after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation. The current systematic review and meta-analysis combined all of the evidence from many relevant studies that evaluated the different forms of surgical or non-operative treatment into one review to assess the overall effects of surgical versus non-operative treatment on patients with lumbar disc herniation.…”

“…Four systematic reviews [10][11][12][13] that compare surgical with non-operative treatment for lumbar disc herniation have been published; however, these systematic reviews focused on different aspects and only vaguely compared the overall effects between the two treatment types. Hence, the current systematic review and meta-analysis attempts to examine the current literature on the overall effects of surgical versus non-operative treatment for patients with lumbar disc herniation.…”

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

“…One study found that at 3, 6, and 12 months post-surgery, 50%, 72%, and 84% of patients were eligible to return to play, respectively [64]. However, it was found that only 38 to 65% of players who underwent surgical treatment for a lumbar disc herniation were able to return to the same level of play as prior to the injury [65]. Additionally, one meta-analysis has noted that the age at which a player undergoes surgery is an important factor in determining career length post-operatively, but the relationship is sport-dependent [65].…”

“…However, it was found that only 38 to 65% of players who underwent surgical treatment for a lumbar disc herniation were able to return to the same level of play as prior to the injury [65]. Additionally, one meta-analysis has noted that the age at which a player undergoes surgery is an important factor in determining career length post-operatively, but the relationship is sport-dependent [65]. In the National Hockey League, regardless of surgical versus non-surgical treatment, players with a lumbar disc herniation played in 56.2 games per season pre-injury versus 39.0 games per season post-injury [66].…”