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 Meta-Analyses (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.
Type
Journal articleSubject
Lumbar spineSurgery
Athletic Injuries
Athletic Performance
Diskectomy
Health Status
Humans
Intervertebral Disc Displacement
Low Back Pain
Lumbar Vertebrae
Return to Sport
Treatment Outcome
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https://hdl.handle.net/10161/11566Published Version (Please cite this version)
10.1136/bjsports-2015-094691Publication Info
Reiman, Michael P; Sylvain, Jonathan; Loudon, Janice K; & Goode, Adam (2016). Return to sport after open and microdiscectomy surgery versus conservative treatment
for lumbar disc herniation: a systematic review with meta-analysis. Br J Sports Med, 50(4). pp. 221-230. 10.1136/bjsports-2015-094691. Retrieved from https://hdl.handle.net/10161/11566.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Adam Payne Goode
Professor in Orthopaedic Surgery
Dr. Goode is an Associate Professor in the Department of Orthopedic Surgery. He is
a physical therapist by clinical training and epidemiologist by scientific training.
His focus is on understanding the etiology of low back pain and other chronic musculoskeletal
conditions and improving the delivery of care for patients with acute and chronic
musculoskeletal conditions. In his research he has published in the areas of the
relationship between individual radiographic features in the lumbar s
Michael Patrick Reiman
Associate Professor in Orthopaedic Surgery
Diagnostic Accuracy of Physical Examination Prediction of overuse musculoskeletal
injury Prediction of return to activity post injuryReturn to sport decision making
and determination
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