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

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Date
2016-02
Authors
Reiman, Michael P
Sylvain, Jonathan
Loudon, Janice K
Goode, Adam
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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 article
Subject
Lumbar spine
Surgery
Athletic Injuries
Athletic Performance
Diskectomy
Health Status
Humans
Intervertebral Disc Displacement
Low Back Pain
Lumbar Vertebrae
Return to Sport
Treatment Outcome
Permalink
https://hdl.handle.net/10161/11566
Published Version (Please cite this version)
10.1136/bjsports-2015-094691
Publication 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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Scholars@Duke

Goode

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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