Best Practice Case Studies-Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: Operative Versus Nonoperative Treatment

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The systematic review and meta-analysis by Sedrak et al. focused on the return to play (RTP) outcomes for elite athletes after symptomatic lumbar disc herniation (LDH), comparing operative and nonoperative treatments. Lumbar disc herniation affects up to 75% of athletes, necessitating effective treatment options for RTP. The study analyzed data from 20 studies encompassing 1,107 athletes, primarily men, across various sports.<br /><br />Key findings included an 83.0% RTP rate for athletes undergoing surgery and an 81.5% RTP rate for those receiving nonoperative care, such as physical therapy and anti-inflammatory medications. The mean time to RTP was slightly longer for the surgical group (5.19 months) compared to the nonoperative group (4.11 months); however, no significant statistical difference was found between the two treatment types regarding RTP rates or speed of recovery.<br /><br />Different surgical techniques were analyzed, including percutaneous endoscopic discectomy (PED), microendoscopic discectomy (MED), and microscopic lumbar discectomy (MLD), with similar RTP outcomes but varied recovery times. The RTP period post-treatment also showed comparable results between approaches, suggesting nonoperative management can be as effective as surgical interventions.<br /><br />Despite the lack of significant differences, the study highlights a tendency to treat elite athletes surgically more often, potentially due to the severity of injuries or a general perception of higher satisfaction rates with surgery in non-athletic populations. The review underscores the need for considering treatment-specific risks, such as potential complications from surgery, when selecting the appropriate care method.<br /><br />The study indicates the necessity for further high-powered, randomized controlled trials to draw more definitive conclusions on LDH management in athletes, and it acknowledges current limitations, including heterogeneity in data reporting and a predominance of male subjects in the studies reviewed.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 55

Topic Spine

Keywords

3rd Edition, CASE 55

3rd Edition

Spine

lumbar disc herniation

return to play

elite athletes

operative treatment

nonoperative treatment

surgical techniques

physical therapy

meta-analysis

randomized controlled trials

sports medicine