Spinal Injuries in the Overhead Athlete.

Purpose Of Review: Treatment of overhead athletes requires a systematic approach that will make an accurate diagnosis, deliver effective treatment, and make timely and safe return to sport.

Recent Findings: New data has shown success rates and return to play effectiveness after different types of cervical and lumbar surgery. Cervical foraminotomy has been shown to have the highest rate and fastest return to play, but with the highest incidence of need for revision surgery.

Cervical Disc Herniations, Radiculopathy, and Myelopathy.

The key to successful treatment of elite athletes is optimizing the medical care at every step: injury prevention and sport-specific training; comprehensive history and physical examination; high-quality and complete diagnostic studies; accurate diagnosis; control and completion of rehabilitation program; minimally invasive, safe, and effective surgeries; risk assessment for return to sport; guided and gradual return to sport; and continued rehabilitation and exercise program after return to sport.

Evidence-Based Management of Spinal Conditions in the Elite Athlete.

Spinal injuries are common and are a significant burden in the professional athlete population. From single-level disk herniation to career-ending fractures, the consequences of these conditions vary widely. Both contact and noncontact injuries can substantially affect the health and performance of elite athletes competing in a variety of sports.

Asymptomatic Spinal Cord Compression: Is Surgery Necessary to Return to Play.

Advising athletes with asymptomatic cervical canal stenosis on their return to active play is a topic of considerable debate, with no definitive guidelines in place. Once cervical canal stenosis is identified, often through imaging following other injuries, it is difficult to predict the risk of future injury upon return to play in both contact and collision sports. Consequently, the decision can be a complicated one for the athlete, family, and physician alike.

The Management of Acute Lumbar Stress Reactions of the Pedicle and Pars in Professional Athletes Playing Collision Sports.

Acute stress reactions in the lumbar spine most commonly occur in athletes at the pars interarticularis followed by the pedicle. These reactions occur as a result of repetitive microtrauma from supraphysiological loads applied to the lumbar spine. Characteristic motions such as trunk extension and twisting are also thought to play a role and may be sport-specific.

Updated Return-to-Play Recommendations for Collision Athletes After Cervical Spine Injury: A Modified Delphi Consensus Study With the Cervical Spine Research Society.

Background: Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after cervical spine injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies.

Objective: To create relevant clinical statements regarding management in collision sport athletes after cervical spine injury, and establish consensus RTP recommendations.

Methods: Following the modified Delphi methodology, a 3 round survey study was conducted with spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for cervical spine injury management in collision sport athletes.

Return to Play After Anterior Cervical Discectomy and Fusion in Professional Athletes.

Background: Data are limited on return to play after anterior cervical discectomy fusion (ACDF) in professional athletes.

Purpose: To determine the rate and time of return to play among professional athletes after ACDF.

Study Design: Case series; Level of evidence, 4.

Sagittal alignment after lumbar interbody fusion: comparing anterior, lateral, and transforaminal approaches.

Study Design: Retrospective radiographic analysis.

Objective: To determine which lumbar interbody technique is most effective for restoring lordosis, increasing disk height, and reducing spondylolisthesis.

Summary Of Background Data: Lumbar interbody fusions are performed in hopes of increasing fusion potential, correcting deformity, and indirectly decompressing nerve roots.

Return-to-play outcomes after microscopic lumbar diskectomy in professional athletes.

Background: It has been shown a microscopic lumbar diskectomy (MLD) is effective in getting professional athletes back to their sport after a herniated nucleus pulposus (HNP). There is a need for more information on the time it takes professional athletes to return after surgery.

Purpose: To determine average time for return to play and success in returning to play for professional athletes undergoing MLD.

Cost-effectiveness of image-guided spine surgery.

Objective: To determine if image-guided spine surgery is cost effective.

Methods: A prospective case series of the first 100 patients undergoing thoracolumbar pedicle screw instrumentation under image-guidance was compared to a retrospective control group of the last 100 patients who underwent screw placement prior to the use of image-guidance. The image-guidance system was NaviVision (Vector Vision-BrainLAB) and Arcadis Orbic (Siemens).

Access strategies for revision in anterior lumbar surgery.

Study Design: Sixty-two consecutive patients undergoing anterior lumbar revision surgery from February 2000 to September 2007 were evaluated for approach strategies and complications.

Objective: To determine the incidence of complications in these patients and to make recommendations on future revisions based on the results obtained.

Summary Of Background Data: Only 2 articles exist in the literature that address this situation and they have widely varying results in a small number of patients.

Anterior instrumentation for thoracolumbar adolescent idiopathic scoliosis: do structural interbody grafts preserve sagittal alignment better than morselized rib autografts?

Study Design: This is a retrospective, sequential cohort study of 34 patients treated by anterior instrumented fusion with single solid rod, single screw constructs with at least 2-year follow-up. Sixteen of the patients received structural grafts as interbody spacers in disc levels below T12, while the other 18 patients received only morselized rib autograft.

Objective: To determine if structural interbody grafts preserve sagittal alignment better than morselized rib autograft.

Vascular injury during anterior lumbar surgery.

Background Context: With the number of anterior lumbar procedures expected to increase significantly over the next few years, it is important for spine surgeons to have a good understanding about the incidence of vascular complications during these operations.

Purpose: To determine the incidence of vascular injury in 1,315 consecutive cases undergoing anterior lumbar surgery at various levels from L2 to S1.

Study Design/setting: Patients undergoing anterior lumbar surgery were studied.

Left iliac artery thrombosis during anterior lumbar surgery.

To determine the incidence of left iliac artery thrombosis (LIAT), a prospective database was maintained on 1315 patients undergoing anterior lumbar surgery (ALS) between August 1997 and December 2002. All had distal pulse evaluation preoperatively. In the last 629 cases pulse oxymetry was used to monitor the distal circulation during and after surgery.

Measurements of lumbopelvic lordosis using the pelvic radius technique as it correlates with sagittal spinal balance and sacral translation.

Background Context: Maintenance of normal lumbar lordosis is important in the treatment of spinal disorders. Many attempts have been made to quantify normal sagittal spinal alignment and lordosis using a C7 plumb line and segmental angulations of the spinal vertebrae. Little attention has been given to pelvic compensation as it correlates to lumbar lordosis and overall sagittal spinal alignment.

Microscopic lumbar discectomy results for 60 cases in professional and Olympic athletes.

Background Context: There is no documented information indicating time for return to play after lumbar discectomy in professional and Olympic athletes.

Purpose: To determine the rate of return to sport and the average time of recovery in elite athletes undergoing microscopic lumbar discectomy (MLD).

Study Design: Between 1984 and 1998, the senior author performed 60 MLDs on 59 professional and Olympic athletes with lumbar herniated nucleus pulposus.

Nerve monitoring changes related to iliac artery compression during anterior lumbar spine surgery.

Background Context: There are no studies in the literature that correlate compression of the iliac vessels resulting in obstruction of blood flow with changes in nerve monitoring parameters during anterior lumbar surgery.

Purpose: To determine whether there is significant compression of the iliac vessels that can cause temporary nerve root ischemia or limb ischemia that could be responsible for loss of somatosensory evoked potentials (SSEP) while retractors are in place for exposure during anterior lumbar interbody fusion (ALIF).

Setting: Patients coming to the operating room for ALIF from levels L2-L3 to L5-S1 would be studied for nerve monitoring changes during the procedure with particular attention to the intervals just before placement of a retractor, while the retractor was in place and immediately after removal of the retractor.

Lymphangiomatosis of the spine: two cases requiring surgical intervention.

Study Design: Two cases of lymphangiomatosis of the spine are presented.

Objectives: To report two cases of lymphangiomatosis of the spine requiring surgical intervention and to review the literature.

Summary Of Background Information: Lymphangiomatosis is a rare childhood disease characterized by abnormal lymph tissue at multiple sites.

Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2.

Study Design: A prospective, nonblinded, multicenter study of outcomes in patients undergoing single-level anterior lumbar discectomy and interbody fusion with InFUSE Bone Graft.

Objective: To determine the safety and effectiveness of InFUSE Bone Graft applied to an absorbable collagen sponge in anterior lumbar interbody fusion with threaded cortical allografts.

Summary Of Background Data: In primates, InFUSE Bone Graft used with allograft dowels was shown to increase rates of interbody fusion by promoting osteoinduction and enhancing incorporation of the allograft.

Lumbar disc injury in the athlete.

The lumbar spine is a highly vulnerable area for injury in a number of different sports. And while the incidence is significant and the time lost may be significant, probably the most important problems are related to the fear of spinal injuries and the need for a therapeutic plan. Lumbar pain is significant in many sports, but an organized diagnostic and therapeutic plan can prevent permanent injury, allowing full function and maximum performance.