By Stylianos N. Kapetanakis, Orthopedic Surgeon - Spine Surgery, Assistant Professor at Democritus University of Thrace, Director of Orthopedics Clinic, Minimal Interventional Spinal Surgery, Athens Medical Center, Head of Spine and Deformities Clinic, European Inter-Balkan Medical Center
Spine disorders are a major cause of impairment of performance, as well as of any sport activities in general. The time of return to pre-surgery activities as well as the gradual increase in the loading of the spine is dependent on both the disorder itself and the method of surgical treatment, as well as the subsequent rehabilitation process, which requires the involvement of the affected athlete, the spine surgeon and rehabilitation specialists (physiotherapist, gymnast).
The latest invasive percutaneous and endoscopic methods are an athlete's ally for quicker recovery and return to performance levels of even a world championship or the Olympic Games, by relieving him/her of pain and a likely neurological deficit without harming the anatomy of the muscles, ligaments and joints of the spine, thus propelling performance.
Microdiscectomy – Endoscopic Discectomy
The most common cause of back pain and sciatica in athletes is the intervertebral disc herniation. In many cases, avoidance of burdening, in combination with medication, is enough to relieve the symptoms.
In the failure of conservative treatment, the spine surgeon is called to provide a solution with microdiscectomy or endoscopic discectomy. In the first case, with minimal muscular detachment and a small bony window, the protruding disc piece is removed and the nerve is released. The patient gets to walk in the same day, starts the physiotherapy of the limb in the first week and after three weeks he/she begins to exercise for strengthening the back. For sports without heavy loads and pressures, the return is set at 6 – 8 weeks, while in fast-paced sports that involve carrying heavy loads and lots of bumping and jumping, gradual recovery with a rehabilitation program allows competition after around 6 months. The endoscopic treatment of the intervertebral disc herniation is the most novel treatment option and promises even faster rehabilitation, due to keeping intact the back support structures, with the first results being very encouraging.
Decompression in central and lateral stenoses
Spinal stenosis usually occurs in athletes of advanced athletic age and is the result of faster degeneration of the osteoligamentous components, mainly in the lumbar spine, due to the chronic increased load on athletes. The latter can now be treated either with a classical surgical removal of the bone causing the stenosis, with semi-laminotomy and foraminotomy under a microscope, or with percutaneous foraminotomy, endoscopic repair and neurolysis. The patient walks straight away, physiotherapy begins in the first week, mild and gradually increasing aerobic exercising begins after 3 to 4 weeks, weights are added in the 6th week, and full recovery is expected - depending on the sports requirements - after 3 to 6 months.
Kyphoplasty – Spondyloplasty
In the case of fractures of the vertebral bodies of the spine with anatomical preservation of the posterior elements, restoration can be achieved percutaneously by injection of a polymer of cement-like qualities, under x-ray control. Relief from pain is almost immediate and the patient can walk immediately. After a short waiting period for the subsiding of ligamental injuries and muscle strains, the athlete returns to full activities in about six weeks.
Spinal fusion
In the case of unstable fractures of the lumbar spine or recurrent symptomatology of isthmic spondylolisthesis, the solution is the performing of stable or dynamic interbody fusion, openly or percutaneously with or without decompression and graft use, to promote the fusion and stabilization of bones and materials. The patient walks after the first 24 hours and physiotherapy of the legs begins from the first week. The strengthening exercises begin after two months and speeding up of the recovery is selected after three months, in order for a good level of fusion to be achieved. In the meantime, recovery has a slower pace. Full reintegration is expected after 6 to 12 months, depending on the requirements of the activity.
