[Sporting loads to Spondylodesis of lumbar spine: The return-to-play process]

Return to play (RTP) and competition following spinal fusion is of particular importance for athletes. There is a lack of guidelines for decision making in RTP processes.

The purpose of this work was to provide a systematic review of the criteria and time of return in the RTP decision process for adults undergoing lumbar spinal fusion.

Two independent investigators searched MEDLINE using MeSH terms. Targeted outcomes were criteria for return to play decisions and total duration of the RTP process.

So far, no prospective randomized controlled trials on RTP after spinal fusion considering inclusion and exclusion criteria are available. Five of the included studies are based on original data. Most of the identified studies are narrative reviews and, thus, exhibit low evidence levels. In addition to the narrative reviews, one observational study, two expert opinion surveys and two model development studies were found.

Based on the literature research, a positive RTP decision can be made if the following criteria are fulfilled: (1) anatomical and functional healing is complete, (2) safety of the athlete and secondary subjects during training and competition is guaranteed, (3) sport-specific skills are regained, and (4) patient is psychosocially ready. The RTP process can often be successfully initiated 6 months after surgery; some patients however, will never manage the return to full-contact sports and/or sports with risk of collision.