Return to sport after posterior spinal fusion for adolescent idiopathic scoliosis: what variables actually have an influence? A retrospective study

Abstract

Purpose To retrospectively evaluate a cohort of athletically active patients who underwent surgery for adolescent idiopathic scoliosis (AIS), and to determine which clinical, surgical and anthropometric variables influenced their return to sport after surgery. Methods 112 adolescents who underwent high-density posterior fusion for AIS by a single surgeon were analyzed for clinical, surgical and demographic predictors of return to presurgical physical activity levels. Data were retrospectively collected by charts and X-rays analysis and patients interviews. Results Preoperative main curve Cobb was 64.4 ± 14.12° and obtained correction was 70.0 ± 12.5%. Included patients played many different sports (Table 4), most of all ballet (44/112, 39.2%), swimming (40/112, 35.7%) and gymnastics (32/112, 28.6%). At an average of 50.3 months follow-up, 76 (67.8%) patients returned to sports (RTS) at an equal or higher level than preoperatively. Younger age, lower Lenke curve type and lower main curve Cobb were significantly associated with RTS. As for RTS timing, patients who returned within the first 6 months were younger, with a higher Lenke and a less severe main curve, a more distal UIV and a more proximal LIV. No complications related to RTS were registered. Conclusion In conclusion, patients with adolescent idiopathic scoliosis safely returned to physical activity after surgery. Younger age, higher Lenke type and lower main curve severity predicted a quicker return to sport. However, prospective studies are needed to confirm these findings.

Return to play following spine surgery

“…An ability to return to their pre-fusion chosen sport is a primary concern for athletes prior to spinal fusion. There is a high probability for return to sports participation at the same level of competition (such as JV, varsity, or club level), with reported rates of return to sport that vary from 59.5% to 96.2% (17)(18)(19)(20)(21)(22). While most patients can compete at similar levels and within the same sport, it is important to note that some athletes may choose to switch sports.…”

“…While most patients can compete at similar levels and within the same sport, it is important to note that some athletes may choose to switch sports. There is a studied trend away from contact and collision sports after spinal fusion surgery, such as horse riding, ballet, soccer and volleyball, to non-contact and non-collision sports, such as cycling and swimming, at rates as high as 37% ( 21 , 23 ).…”

“…Various other factors have been proposed as more predictive of rates of return to play. Spine outcomes scores (SRS-22), young age, lower curve magnitude, and Lenke classification have been reported as significant of factors for timing and/or ability to return to sport ( 17 , 21 ). It is likely that the lack of consensus or consistent findings in return to sports studies is due to the variation in the studies themselves, including: heterogeneity of the subjects (both in age, level of competition, and sport type); study design (study size, predominantly retrospective); variety in outcome measures (return to any sport, change in sport, classification of level of participation); surgical variables (including the extent of correction, restoration of sagittal alignment, or anchor choices); or inability to capture external factors (such as a change in preferences, school or social circumstances that may drive an athlete out of sport).…”

“…In more contemporary studies evaluating return to play, however, complications were rare—one instance of set cap dislodgement was noted at 3 years post-op ( 22 ) and one patient had failure of their implants when returning to snowboarding before release to activity at only two weeks after surgery ( 27 ). Many authors report no early complications related to return to sport ( 17 , 20 , 21 ). However these studies were limited by length of follow-up, which ranged from one ( 19 ) to 5.5 years ( 17 ).…”

Return to Sport after Adolescent Idiopathic Scoliosis (AIS) Correction Surgery: A Retrospective Data Analysis

“…In contrast, they could not recognize any patient or curve characteristics (Lenke type, LIV) that were associated with a delay in sport resumption [ 17 ]. On the other hand, Ruffilli et al recognized in their survey of 112 AIS patients that a younger age, higher Lenke type and less severe main curve predicted a faster return to sport activities [ 18 ]. In our opinion, further investigations are needed to establish common recommendations in terms of the postoperative timepoint of returning to sport activities.…”