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Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment

CONTEXT: The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in term...

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Autores principales: Sedrak, Phelopater, Shahbaz, Mustafa, Gohal, Chetan, Madden, Kim, Aleem, Ilyas, Khan, Moin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404721/
https://www.ncbi.nlm.nih.gov/pubmed/33563131
http://dx.doi.org/10.1177/1941738121991782
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author Sedrak, Phelopater
Shahbaz, Mustafa
Gohal, Chetan
Madden, Kim
Aleem, Ilyas
Khan, Moin
author_facet Sedrak, Phelopater
Shahbaz, Mustafa
Gohal, Chetan
Madden, Kim
Aleem, Ilyas
Khan, Moin
author_sort Sedrak, Phelopater
collection PubMed
description CONTEXT: The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also speed of recovery. OBJECTIVE: The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of LDHs. DATA SOURCES: A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies. STUDY SELECTION: Yielded studies were screened according to the inclusion criteria. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Relevant data were extracted. A meta-analysis was performed comparing RTP rate for all comparative studies. RESULTS: Twenty studies met the inclusion criteria and were included in this review. Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and 251 out of 308 patients (81.5%) returned to play in the nonoperative group. No statistically significant difference for RTP rate was found (odds ratio, 1.39; 95% CI, 0.58-3.34; P = 0.46; I2, 71%). The mean time to RTP for patients undergoing lumbar discectomy was 5.19 months (range 1.00-8.70 months), and 4.11 months (range 3.60-5.70 months) for those treated conservatively. CONCLUSION: There was no significant difference in RTP rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to RTP. Athletes should consider the lack of difference in RTP rate in addition to the potential risks associated with spinal surgery when choosing a treatment option. Future randomized controlled trials are needed on this topic to allow for high-powered conclusions.
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spelling pubmed-84047212021-09-02 Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment Sedrak, Phelopater Shahbaz, Mustafa Gohal, Chetan Madden, Kim Aleem, Ilyas Khan, Moin Sports Health Focus Topic: The Elite Athlete CONTEXT: The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also speed of recovery. OBJECTIVE: The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of LDHs. DATA SOURCES: A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies. STUDY SELECTION: Yielded studies were screened according to the inclusion criteria. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Relevant data were extracted. A meta-analysis was performed comparing RTP rate for all comparative studies. RESULTS: Twenty studies met the inclusion criteria and were included in this review. Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and 251 out of 308 patients (81.5%) returned to play in the nonoperative group. No statistically significant difference for RTP rate was found (odds ratio, 1.39; 95% CI, 0.58-3.34; P = 0.46; I2, 71%). The mean time to RTP for patients undergoing lumbar discectomy was 5.19 months (range 1.00-8.70 months), and 4.11 months (range 3.60-5.70 months) for those treated conservatively. CONCLUSION: There was no significant difference in RTP rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to RTP. Athletes should consider the lack of difference in RTP rate in addition to the potential risks associated with spinal surgery when choosing a treatment option. Future randomized controlled trials are needed on this topic to allow for high-powered conclusions. SAGE Publications 2021-02-10 /pmc/articles/PMC8404721/ /pubmed/33563131 http://dx.doi.org/10.1177/1941738121991782 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Focus Topic: The Elite Athlete
Sedrak, Phelopater
Shahbaz, Mustafa
Gohal, Chetan
Madden, Kim
Aleem, Ilyas
Khan, Moin
Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment
title Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment
title_full Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment
title_fullStr Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment
title_full_unstemmed Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment
title_short Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment
title_sort return to play after symptomatic lumbar disc herniation in elite athletes: a systematic review and meta-analysis of operative versus nonoperative treatment
topic Focus Topic: The Elite Athlete
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404721/
https://www.ncbi.nlm.nih.gov/pubmed/33563131
http://dx.doi.org/10.1177/1941738121991782
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