Spine Treatment Appraisal Report (STAR): Return-to-Play in Elite Athletes After Symptomatic Lumbar Disc Herniation: Surgery or Non-Surgical Treatment?

Abstract

Citation: Sedrak P, Shahbaz M, Gohal C, Madden K, Aleem I, Khan M. Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment. Sports Health. Feb 10 2021:1 941 738 121 991 782.

Visual Abstract

This is a visual representation of the abstract.

Why Is This Study An Important Topic?

Elite athletes present a different clinical picture from the average population. The prevalence of symptomatic disc degeneration in elite athletes can be as high as 75%. Surgical management is often the treatment of choice in these athletes, with the aim of maximizing the potential and speed of return to sports. Therefore, comparing return to sport outcomes between surgical and non-surgical care is warranted.

What Was the Primary Clinical Question?

In elite athletes with lumbar disc herniation, is there a difference in return-to-play (RTP) outcomes between surgical and non-surgical care?

Study Characteristics

Population: Included: Male (98%) and female (2%) adult elite athletes with symptomatic lumbar disc herniation, mean age 28.3 years (range 14-49) Excluded: Pediatric patients, recreational or nonprofessional athletes

Treatment: Surgical discectomy (n=799)

Control: Non-surgical management (n=149)

Outcomes: Proportion of athletes returning to play Time to return-to-play

Time: Mean followup 36 months (range 6-73)

Results

Result 1. Proportion of elite athletes RTP.

Result 2. Forest Plot for RTP.

Result 3. Time to RTP (mean and range)

How Will This Affect the Care of My Patients?

Nonsurgical treatment appears to produce similar RTP outcomes compared with surgical intervention. This finding could be of use to practitioners and athletes in conjunction with pretreatment profiles as treatment options are considered.