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Camino-Willhuber G, Tani S, Kelly MJ, Schonnagel L, Caffard T, Chiapparelli E, Gorgy G, Dalton D, Zhu J, Shue J, Zelenty WD, Cammisa FP, Girardi FP, Hughes AP, Sama AA, Sokunbi G. Discrepancies in recommendations for return to regular activities after cervical spine surgery: A survey study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100316. [PMID: 38572467 PMCID: PMC10987327 DOI: 10.1016/j.xnsj.2024.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
Background The recommended timing for returning to common activities after cervical spine surgery varies widely among physicians based on training background and personal opinion, without clear guidelines or consensus. The purpose of this study was to analyze spine surgeons' responses about the recommended timing for returning to common activities after different cervical spine procedures. Methods This was a survey study including 91 spine surgeons. The participants were asked to complete an anonymous online survey. Questions regarding their recommended time for returning to regular activities (showering, driving, biking, running, swimming, sedentary work, and nonsedentary work) after anterior cervical decompression and fusion (ACDF), cervical disc replacement (CDR), posterior cervical decompression and fusion (PCDF), and laminoplasty were included. Comparisons of recommended times for return to activities after each surgical procedure were made based on surgeons' years in practice. Results For ACDF and PCDF, there were no statistically significant differences in recommended times for return to any activity when stratified by years in practice. When considering CDR, return to non-sedentary work differed between surgeons in practice for 10 to 15 years, who recommended return at 3 months, and all other groups of surgeons, who recommended 6 weeks. Laminoplasty surgery yielded the most variability in activity recommendations, with earlier recommended return (6 weeks) to biking, non-sedentary work, and sedentary work in the most experienced surgeon group (>15 years in practice) than in all other surgeon experience groups (3 months). Conclusions We observed significant variability in surgeon recommendations for return to regular activities after cervical spine surgery.
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Affiliation(s)
- Gaston Camino-Willhuber
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Soji Tani
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Michael J. Kelly
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Lukas Schonnagel
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Thomas Caffard
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Erika Chiapparelli
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - George Gorgy
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - David Dalton
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
| | - Jennifer Shue
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - William D. Zelenty
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Frank P. Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Federico P. Girardi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Alexander P. Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Andrew A. Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
| | - Gbolabo Sokunbi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, United States
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Fujimoto S, Inokuchi T, Tamaki S, Sugiura K, Takeuchi M, Morimoto M, Tezuka F, Yamashita K, Fujitani J, Sairyo K. Return-to-play outcomes after full-endoscopic spine surgery under local anesthesia in professional baseball players: Comparison by timing of surgery. J Orthop Sci 2024:S0949-2658(24)00007-1. [PMID: 38302309 DOI: 10.1016/j.jos.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Full-endoscopic spine surgery via a transforaminal approach (TF-FESS) is minimally invasive and could help athletes quickly return to play. When treating professional athletes, we have to consider their season schedule. In this study, we investigated the characteristics of Japanese professional baseball players who underwent TF-FESS and examine how the timing of surgery influenced their postoperative course. METHODS Ten players who underwent TF-FESS (discectomy, foraminoplasty, or thermal annuloplasty according to their diagnosis) under local anesthesia were analyzed. Multilevel surgeries were performed at the same time in patients with lesions at multiple levels. The patients were divided into three groups according to timing of surgery (pre/during/post-season). Time to complete return to play and duration of official game loss were compared between the three groups. RESULTS All players (100 %) could return to their original level of professional play after FESS surgery. Seven of the 10 patients underwent two-level surgery. The mean time until complete return to play was 4.6 months (range, 2-8 months) and the mean duration of game loss was 1.5 months (range, 0-4 months). The mean duration of game loss was shorter in the post-season group than in the other groups (0.9 vs 2,4 months), and 4 of 6 patients in the post-season group did not miss any games. CONCLUSIONS TF-FESS is a good technique for achieving a quick return to play in professional baseball players. In particular, surgery performed during the post-season could allow players to return to play after adequate rehabilitation with no game loss.
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Affiliation(s)
- Shutaro Fujimoto
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-8543, Hokkaido, Japan
| | - Takashi Inokuchi
- Department of Orthopedics, Chikamori Hospital, 1-1-16, Okawasuji, Kochi 780-8522, Kochi, Japan
| | - Shunsuke Tamaki
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Makoto Takeuchi
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Junzo Fujitani
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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Jo J, Davidar AD, Hersh AM, Theodore N, Zuckerman SL. Cervical and Lumbar Disk Replacement in Athletes: Is It Safe to Return to Play? A Systematic Review of the Scientific Literature and Lay Press. Neurosurgery 2024; 94:4-13. [PMID: 37607091 DOI: 10.1227/neu.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cervical/lumbar total disk replacements (TDRs) are often performed for degenerative conditions but rarely in athletes. Therefore, we sought to conduct a systematic review of athletes undergoing TDRs of both the scientific literature and lay press, with an emphasis on contact sport athletes. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed/Embase/Cochrane/Scopus/Web of Science databases were queried for all primary literature reporting TDRs in athletes, including both cervical/lumbar disk replacements (CDRs/LDRs). Sports were dichotomized into contact vs limited/noncontact. Because of the public nature of injuries in elite athletes, the lay press was also queried. RESULTS A total of 488 scientific studies were screened, of which 10 met inclusion criteria. Cervical: seven studies reported CDRs in 53 athletes, of which 7 were professional, 22 semiprofessional, and 24 recreational. Of the seven professional athletes, there was one contact sport athlete (kickboxer). All 7/7 professional and 21/22 semiprofessional athletes successfully returned-to-play at 8-52 weeks without complication. Lumbar: Three studies discussed LDRs in 51 athletes, of which 17 were professional, 6 semiprofessional, and 28 recreational. Of the 17 professional athletes, eight played contact sports (2 boxing, 2 alpine skiing, 2 soccer, judo, rugby). All 17 professional and 6 semiprofessional athletes successfully returned to play at 9-21 weeks. Lay Press: five professional contact sport athletes underwent CDRs, and all returned to play: 3 hockey, 1 mixed-martial arts, and 1 Australian-rules football. CONCLUSION The scientific literature and lay press revealed 14 professional contact sport athletes who underwent TDR-6 CDRs and 8 LDRs-all with successful return to play. From the little data that exist, it seems that TDR may be safe in elite athletes; however, the small number of patients highlights the major paucity of data on the safety of TDR in elite contact sport athletes.
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Affiliation(s)
- Jacob Jo
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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Clohisy JCF, Maayan O, Asada T, Qureshi SA. Cervical Total Disc Replacement in Athletes: A Systematic Review. Clin Spine Surg 2023; 36:369-374. [PMID: 37735765 DOI: 10.1097/bsd.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To perform a systematic review to describe clinical characteristics, outcomes, and return to play after cervical total disc replacement (cTDR) in athletes. SUMMARY OF BACKGROUND DATA The role of cTDR in treating athletes with symptomatic cervical degenerative disc disease is undefined. METHODS A systematic search using MEDLINE through PubMed, EMBASE, and the Cochrane Library was conducted to identify all relevant literature. Data regarding study type, country in which the study was conducted, sample size, mean age, sex, type of sport, level of patient participation in sports, surgical indication, levels operated, type of implant, duration of follow-up, reoperations, surgical complications, extent of postoperative return to sports (RTSs), time to RTSs, and outcome notes were extracted from the included studies and analyzed. RESULTS Seven studies, including 4 case series and 3 case reports, and a total of 57 cTDR cases, were included. There was significant heterogeneity among the cTDR cases in terms of chosen sport and level of participation. Prestige LP was utilized in 51 out of 57 (89.5%) cases and 53 out of 57 (93%) cases were single-level. No reoperations were noted at a mean follow-up of 51.6 months. All patients returned to sports postoperatively. Return to training and competition occurred at a mean of 10.1 weeks and 30.7 weeks postoperatively, respectively. CONCLUSIONS The available evidence regarding cTDR in athletes indicates that these patients RTSs at high rates, with return to training occurring around 10 weeks and return to competition occurring around 30 weeks. Clinical outcomes in these patients are like those reported for the general population. Low-level evidence, small numbers of cases, heterogeneity in chosen sport and participation level, and predominance of a single implant type limit the conclusions that can be drawn from the current literature on this patient population.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Reiter CR, Nelson CT, Satalich JR, O'Neill CN, Cyrus JW, O'Connell RS, Vap AR. Return to sport and active military duty after cervical disc arthroplasty: A systematic review. J Orthop 2023; 39:75-82. [PMID: 37113977 PMCID: PMC10126923 DOI: 10.1016/j.jor.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Cervical disc arthroplasty (CDA) has been established as an effective treatment for cervical disc degeneration or herniation in the general population. Return to sport (RTS) outcomes in athletes remain unclear. Objective The purpose of this review was to evaluate RTS following single-level, multi-level, or hybrid CDA, with additional return to activity context provided by return to duty (RTD) outcomes in active-duty military. Methods Medline, Embase, and Cochrane were searched through August 2022 for studies that reported RTS/RTD after CDA in athletic or active-duty populations. Data was extracted on the following topics: surgical failures/reoperations, surgical complications, RTS/RTD, and postoperative time to RTS/RTD. Results Thirteen papers covering 56 athletes and 323 active-duty members were included. Athletes were 59% male with a mean age of 39.8 years and active-duty members were 84% male with a mean age of 40.9 years. Only 1 of 151 cases required reoperation and only 6 instances of surgical complications were reported. Classified as return to general sporting activity, RTS was observed in 100% of patients (n = 51/51) after an average of 10.1 weeks to training and 30.5 weeks to competition. RTD was observed in 88% of patients (n = 268/304) after an average of 11.1 weeks. Average follow-up was 53.1 months for athletes and 13.4 months for the active-duty population. Conclusion CDA displays excellent RTS and RTD rates in physically demanding populations at rates superior or equivalent to alternative treatments. Surgeons should consider these findings when determining the optimal cervical disc treatment approach in active patients.
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Affiliation(s)
- Charles R. Reiter
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Chase T. Nelson
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - James R. Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Conor N. O'Neill
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - John W. Cyrus
- Health Sciences Library, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert S. O'Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Alexander R. Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
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Satalich J, Wyatt P, O'Neill C, Kalluri P, O'Connell R. Cervical Disk Arthroplasty in a Collegiate Football Player. J Orthop Case Rep 2022; 12:41-43. [PMID: 36873322 PMCID: PMC9983398 DOI: 10.13107/jocr.2022.v12.i09.3008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction While the body of research investigating anterior cervical disk fusion (ACDF) for symptomatic cervical disk herniations in high-level athletes is large, evidence for cervical disk replacement (CDR) is sparse. The amount of patients able to return to sport after an ACDF is estimated to be 73.5%, causing surgeons to search for alternatives with better outcomes in this population. This case report describes the successful treatment of a symptomatic collegiate American football player with C6-C7 disk herniation and C5-C6 central canal stenosis. Case Report This is a 21-year-old American football safety who underwent a C5-6 and C6-7 cervical disk arthroplasty. Three weeks postoperatively, the patient demonstrated nearly complete resolution of weakness, full resolution of radiculopathy, and normal cervical range of motion in all planes. Conclusion The CDR may be considered as an alternative to the ACDF in the treatment of high-level contact athletes. Compared to the ACDF, CDR has been shown in prior studies to decrease the long-term risk of adjacent segment degeneration. Future studies comparing ACDF to CDR in the high-level contact sport athlete population are needed. CDR appears to be a promising surgical intervention for symptomatic patients in this population.
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Affiliation(s)
- James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Phillip Wyatt
- Department of Orthopaedics, VCU Medical School, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Conor O'Neill
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Prakasam Kalluri
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Robert O'Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
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Efficacy of NHP66 Bioactive Cage on Patients with Cervical Spine Injury in Short-Track Speed Skating. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6088398. [PMID: 35132331 PMCID: PMC8817875 DOI: 10.1155/2022/6088398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
Background Short-track speed skating (STSS) is an extreme sport in pursuit of extreme speed and explosive force. In such a sport, once athletes fall down, they are susceptible to serious cervical spine injury (CSI) under the inertia of high-velocity movement. Nanohydroxyapatite/polyamide 66 (NHP66) bioactive cage is a high-tech product of nanotechnology in the medical field in recent years. With a structure similar to that of human cortical bone, NHP66 bioactive cage has extremely high toughness and strength, which tailors to the needs of STSS. Objective This study mainly analyzed the therapeutic effect of NHP66 on patients with CSI in STSS, aiming to provide new opportunities for the treatment of this patient population. Methods A total of 51 patients with CSI treated in our hospital were enrolled, including 19 cases of short-track speed skaters (observation group) and 32 cases of car accidents, falls from heights, or collision injuries (control group). The relevant surgical indicators (operation time, intraoperative blood loss, etc.), the incidence of adverse reactions, the Cobb angle of cervical lordosis before and after surgery, and the fusion segment height of the cage were observed and compared between the two groups. Postoperative pain was evaluated by the visual analog scale (VAS), improvement of spinal cord injury was assessed by the American Spinal Cord Injury Association (ASIA) Impairment Scale, and bone fusion, bone subsidence, and other motor functions were assessed by the Japanese Orthopaedic Association (JOA) score rating system. Results The operation time, intraoperative blood loss, and incidence of adverse reactions in the observation group were significantly lower than those in the control group. The Cobb angle of cervical lordosis and the fusion segment height of cage increased significantly higher in both groups after surgery. In addition, the VAS scores of the observation group 2 h and 3 d after operation were significantly lower than those of the control group. In terms of improvement of spinal cord injury, ASIA and JOA scores in the observation group were significantly higher than those before treatment and in the control group. There was no significant difference in bone fusion activity between the two groups. Conclusions In this study, it is found through experiments that NHP66 has higher safety and application value than autogenous iliac bone, confirming that NHP66 can achieve significant results as a cage for anterior cervical decompression and iliac bone graft fusion and internal fixation in short-track speed skaters after CSI.
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Satalich J, Carter S, Fisichella A, Widmeyer J, Kalluri P, Vap A. Return to Football after a Cervical Disk Arthroplasty: A Case Report. J Orthop Case Rep 2022; 12:19-21. [PMID: 36660162 PMCID: PMC9826549 DOI: 10.13107/jocr.2022.v12.i05.2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/15/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Symptomatic cervical spine disk hernations in high-level athletes are traditionally treated with anterior cervical disk fusion (ACDF) after failed conservative management. Unfortunately, an ACDF comes with decreased mobility and only a return to sport 73.5% of the time. In high-level athletes, mobility and range of motion can be critical to their long-term success. This case report will discuss the successful treatment of a C6-C7 disk herniation with a cervical disk replacement (CDR). Case Report This is a 23-year-old football player whom had a left paracentral C6-C7 disk herniation causing foraminal stenosis. He had significant triceps muscle wasting and weakness and he was not able to participate in football secondary to his symptoms. After failing 6 weeks of conservative, he underwent a CDR. At 8 weeks postoperatively, he was cleared for football and return to sport without complications. Conclusion The CDR provides high-level athletes the ability to return to contact sports safely. In this unique case, we present a division one football player with a symptomatic cervical herniated disk that was treated with a CDR and return to sport without any limitations or complications. The CDR was able to treat symptoms, improve strength and motion, and ultimately allow the player to return to football. More studies need to be performed, but ultimately CDR in athletes can get them back on the field, improve their cervical range of motion, and decrease their risk of adjacent segment disease in the long run when compared to the cervical fusion.
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Affiliation(s)
- James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Sean Carter
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Anthony Fisichella
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Jonathan Widmeyer
- VCU Medical School, Virginia Commonwealth University Hospital, Richmond, Virginia,Address of Correspondence: Mr. Jonathan Widmeyer, Virginia Commonwealth University Hospital, Richmond, Virginia. E-mail:
| | - Prakasam Kalluri
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia
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Wojtys EM. The Team Doc and Injury Care. Sports Health 2021; 13:421-422. [PMID: 34449298 DOI: 10.1177/19417381211036115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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