Spinal Surgery and Return to Play

This session included presentations on: Endoscopic lumbar discectomy; Spondylosis in sports; Cervical spine; and a Round table discussion of RTP in three case studies.

Endoscopic lumbar discectomy enables very rapid recovery with reduced post-operative pain and no post-operative restrictions or limitations. Patients can get back to training a few days after surgery and return to competition within a few weeks. Out of a total of over 10,000 procedures, mainly at L5–S1 and L4–L5, the most common complication was recurrence (5.5%). Most patients (86%) recover well from spondylosis with conservative management. Of the remaining 14%, some either reduce their activity levels or go on to have surgery. The surgery depends on the type of fracture: incomplete or acute complete fracture; complete fracture with separation; or complex fracture. Surgery is performed as a day case or with an overnight stay, followed by a simple corset for 6 weeks and then a personalised rehab programme, which aims for complete function at 4–6 months. Treatment at the cervical spine is divided into two groups of patients: those with cervical disc prolapse and those with spinal trauma. For disc prolapse, avoid surgery if possible, or if not do enough but limit the number of levels that are operated on. Following rehab, radiological assessment is required before RTP to confirm the position of the prosthesis and no loosening; dynamic stability; and union. There is very little evidence for best practice, and although guidelines have been issued (Cantu, Torg, Vaccaro) there is significant disagreement. Patient’s should be managed on an individual basis using basic principles of stability and neurological assessment. The session finished with a discussion of three case studies.