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Return-to-Sport Recommendations in Athletes Requiring Cervical Spine Surgery: A Modified Delphi Consensus Survey of
Scott L Zuckerman1,2, Michael White3, Grant H Rigney1,4
1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Study Design:
Modified Delphi consensus survey.
Objective:
To survey expert opinion on postoperative return-to-sport (RTS) decisions in athletes requiring cervical spine surgery.
Summary Of Background Data:
Postoperative sport participation recommendations for athletes requiring cervical spine surgery are lacking, and management of these athletes remains challenging.
Methods:
A cross-sectional, modified Delphi consensus survey investigating RTS decisions in athletes requiring various cervical spine operations was undertaken. A panel of neurosurgery/orthopedic spine surgeons with sport expertise was identified from the United States and Australia. Single and multilevel cervical spine conditions studied included: anterior cervical discectomy and fusion (ACDF), cervical laminectomy and/or laminoplasty, posterior cervical fusion, occipito-cervical fusion, C1 fracture, and C1-C2 fusion. A 2×2 scheme was used to classify sport risk based on impact forces and frequency: low impact/low frequency, low impact/high frequency, high impact/low frequency, and high impact/high frequency. Consensus was a priori defined at ≥70%. Descriptive statistics were performed.
Results:
Of the 34 sports spine surgeons invited (56% neurosurgeons and 44% orthopedic surgeons), survey completion was 100%. Consensus was achieved to recommend return to high-impact/high-frequency sport for individuals with one-level ACDF, one-level cervical laminectomy, one-level posterior cervical fusion, and for a healed C1 fracture treated with open reduction and internal fixation. For individuals with a healed occipito-cervical fusion, consensus was achieved to recommend return to low-impact/low-frequency sport.
Conclusions:
Consensus was achieved to recommend return to high-impact/high-frequency sport after surgical treatment of a variety of cervical pathologies in athletes. Certain situations received consensus recommendations to return to low-impact/low-frequency sport, whereas many others did not reach a consensus. These results provide useful data that can help spine surgeons navigate challenging postoperative RTS decisions.
