Athletic activity after spine surgery in children and adolescents: results of a survey.

Rubery PT, Bradford DS. Spine 2002 Feb 15;27(4):423-7

STUDY DESIGN: Questionnaire-based survey. OBJECTIVES: To poll the members of the Scoliosis Research Society regarding their opinions and experience with athletic activity after spine surgery performed on children and adolescents. SUMMARY OF BACKGROUND DATA: Athletic activity is increasingly important in society. Patients are very concerned about returning to sports and exercise after spinal surgery. There are no generally accepted guidelines for surgeons regarding either appropriate sports or the appropriate time to resume sports after spinal surgery. METHODS: A survey was designed by the authors and reviewed by a statistical consultant. The form was mailed to the 721 individuals on the Scoliosis Research Society mailing list. Returned surveys were hand scored and entered into an Excel spreadsheet. RESULTS: Of the 316 forms returned, 278 indicated that the respondent performed spinal fusion on children and adolescents. Two hundred sixty-one completed forms, representing approximately 45% of the society’s estimated active clinicians, were reviewed. Formal physical therapy was unlikely to be recommended by members of the society regardless of procedure, although postoperative home exercise was used by many after spondylolisthesis fusion. The majority of patients were returned to gym class between 6 months and 1 year (range, immediate to never) after surgery. Most respondents returned patients to noncontact sports between 6 months and 1 year postoperatively. Contact sports were generally withheld until 1 year after surgery. Close to 20% of respondents required, and 35% suggested, that patients never return to collision sports. Twenty percent of respondents for scoliosis and 5% for spondylolisthesis reported having notable adverse outcomes attributed to athletic activity. CONCLUSION: These survey results show the varying approaches taken by members of the Scoliosis Research Society to postoperative athletic activity, and they provide a starting point for investigations regarding alternative approaches.

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Omey ML, Micheli LJ, Gerbino PG 2nd. Clin Orthop 2000 Mar;(372):74-84

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors’ institution is presented.

Recommendations for participation in sports by patients with idiopathic scoliosis

Hopf C, Felske-Adler C, Heine J. Z Orthop Ihre Grenzgeb 1991 Mar-Apr;129(2):204-7

Presented is the recommendation of the “Arbeitskreis Skoliose” of the DGOT concerning the sporting activities for juvenile patients suffering from an idiopathic scoliosis. The main points of this concept are the desirable active participation in school sport activities and the ascertainment that restrictions are not necessary in scolioses up to 21 degrees. A special recommendation for operated patients predicates the begin of sport activities after one year postoperatively. The kind of sport must be recommended by the surgeon, high-performance sports cannot be tolerated in those patients. Precondition for these recommendations are regularly physical examinations by the orthopedic physician and standardized x-rays in standing position

Adolescent idiopathic scoliosis.

Roach JW. Orthop Clin North Am 1999 Jul;30(3):353-65, vii-viii

Because of the relatively recent understanding of the untreated natural history of idiopathic scoliosis, many patients do not require treatment and are simply observed. Immature patients whose curves are between 25 degrees and 40 degrees are at high risk for further progression and should be treated with a brace. Seventy percent to 80% of the time, the patient can expect that the brace will prevent further progression. Curves in growing children greater than 40 degrees require a spinal fusion. Modern scoliosis surgery provides excellent correction of deformity and allows immediate ambulation without a cast or brace. This article reviews the diagnosis, cause, and treatment recommendations for adolescent idiopathic scoliosis.

Utility of three-dimensional and multiplanar reformatted computed tomography for evaluation of pediatric congenital spine abnormalities.

Newton PO, Hahn GW, Fricka KB, Wenger DR. Spine 2002 Apr 15;27(8):844-50

STUDY DESIGN: A retrospective radiographic review of 31 patients with congenital spine abnormalities who underwent conventional radiography and advanced imaging studies was conducted. OBJECTIVE: To analyze the utility of three-dimensional computed tomography with multiplanar reformatted images for congenital spine anomalies, as compared with plain radiographs and axial two-dimensional computed tomography imaging. SUMMARY OF BACKGROUND DATA: Conventional radiographic imaging for congenital spine disorders often are difficult to interpret because of the patient’s small size, the complexity of the disorder, a deformity not in the plane of the radiographs, superimposed structures, and difficulty in forming a mental three-dimensional image. Multiplanar reformatted and three-dimensional computed tomographic imaging offers many potential advantages for defining congenital spine anomalies including visualization of the deformity in any plane, from any angle, with the overlying structures subtracted. METHODS: The imaging studies of patients who had undergone a three-dimensional computed tomography for congenital deformities of the spine between 1992 and 1998 were reviewed (31 cases). All plain radiographs and axial two-dimensional computed tomography images performed before the three-dimensional computed tomography were reviewed and the findings documented. This was repeated for the three-dimensional reconstructions and, when available, the multiplanar reformatted images (15 cases). In each case, the utility of the advanced imaging was graded as one of the following: Grade A (substantial new information obtained), Grade B (confirmatory with improved visualization and understanding of the deformity), and Grade C (no added useful information obtained). RESULTS: In 17 of 31 cases, the multiplanar reformatted and three-dimensional images allowed identification of unrecognized malformations. In nine additional cases, the advanced imaging was helpful in better visualizing and understanding previously identified deformities. In five cases, no new information was gained. The standard and curved multiplanar reformatted images were best for defining the occiput-C1-C2 anatomy and the extent of segmentation defects. The curved multiplanar reformatted images were especially helpful in keeping the spine from “coming in” and “going out” of the plane of the image when there was significant spine deformity in the sagittal or coronal plane. The three-dimensional reconstructions proved valuable in defining failures of formation. CONCLUSIONS: Advanced computed tomography imaging (three-dimensional computed tomography and curved/standard multiplanar reformatted images) allows better definition of congenital spine anomalies. More than 50% of the cases showed additional abnormalities not appreciated on plain radiographs or axial two-dimensional computed tomography images. Curved multiplanar reformatted images allowed imaging in the coronal and sagittal planes of the entire deformity.